ICD-10 General FAQs

General FAQs

Q: Why are we moving to ICD-10?
ICD-10 is a more advanced and robust coding set than ICD-9. This allows for complex and detailed reporting that better meets the needs of the health care industry today. The move to ICD-10 will increase the level of specificity available for research, public health, and other purposes.

Q: When is the compliance date for ICD-10?
ICD-10 compliance is required for service on or after October, 1, 2015. Get more information, by vhttp://practicemax.com/challenges-we-solve/maximizing-reimbursements/

Q: Who is required to use ICD-10 codes?
ICD-10 compliance is mandatory for all HIPAA covered entities, not only Medicare. There are no exceptions for any HIPAA covered entities. If entities are not covered by HIPAA they are not required to comply with ICD-10. This includes worker’s compensation and liability carriers. Continue reading¬†http://practicemax.com/markets-we-serve/senior-living/assisted-living/

Q: Can I just “crosswalk” my ICD-9 codes to ICD-10?
No. Crosswalks or equivalence mapping are for general knowledge and often map only to codes that do not contain sufficient specificity based on what is clinically known at the time of service. These unspecified codes may fail to provide medical necessity for the services rendered. “Native” or source document coding is recommended. In native coding, an ICD-10 diagnosis code is directly assigned based on information that is documented in the clinical record.

Q: Can I just let my coder deal with ICD-10?
ICD-10 requires more specificity and coders can only code based on the documentation available to them. If the documentation is not complete and does not provide the necessary detail, the coder will not be able to assign the most appropriate code. If you utilize the service of certified coders the documentation must have a level of specificity to assign the most appropriate codes for you.

Q: I heard there might be another delay in ICD-10. Is that true?
No. There will not be another delay in the ICD-10 transition deadline. CMS has advised that they will allow for a degree of flexibility during the first year of implementation. This flexibility includes several restrictions and does NOT apply to Medicaid, Commercial or other payors. For more details on CMS flexibility, click here.

Q: Will our cash flow be impacted by the transition?
Yes. To what extent may be within your control. To reduce the possibility of delayed or denied claims, you should document specific diagnoses with as much detail as clinically available at the time of service. This will ensure that the claim has the best possible chance to be adjudicated.

Q: Will I need an ICD-10 code if I am requesting a prior authorization in September for an October service?
This will depend on the payor. Be prepared to provide ICD-10 codes for ALL prior authorization related to service on or after 10/1/15.