Electronic Claim Filing: 7 Facts about ICD-10

The October 1st implementation date for ICD-10 is approaching faster than you think, and it will undoubtedly bring with it some changes for your eyecare practice and electronic claim filing processes. While many people fear change, we want to urge you to be open to the changes ICD-10 will bring to your practice. The new code set is designed to increase specificity in medical coding which will help with your practice’s efficiency. And, in all honesty, if you take the time to educate yourself on the changes you’ll realize they aren’t as intimidating as you may think.

Today we want to walk you through seven ICD-10 facts, some of them coming straight from the CMS, and two actions your practice can take to get ready, that will hopefully put you at ease about the new code set, and maybe even get you excited for the change!

7 ICD-10 Facts that Could Affect Your Eyecare Practice Efficiency

1. The ICD-10 transition date is October 1, 2015. October-1

  • The implementation date for ICD-10 is October 1st, and no matter how much you will it to, the date is not going to be pushed back. The government, payers, and providers have all invested a large amount of money in the preparation for ICD-10, and pushing the date back would cause a rise in healthcare costs, so get ready!

2. You don’t have to use all 68,000 codes.

  • Does your practice use every single code in ICD-9? No, and you won’t have to use every single code in ICD-10 either. Your practice will be focusing on a subset of the codes that is specific to eyecare, so don’t let that large new number scare you!more

3. Looking up codes in ICD-10 will be similar to looking up codes in ICD-9.

  • ICD-10 will be equipped with similar tools to the ones you are already used to in ICD-9, including an alphabetic index and electronic tools. The process of looking up codes in ICD-10 will be very similar to what you already are doing, helping to make the transition for you as smooth as possible.

4. Outpatient and office procedure codes aren’t changing.

  • In ICD-10 you’ll continue to use CPT for outpatient and office procedure codes, so you won’t have to learn a new set of codes in those areas.

5. All Medicare fee-for-service providers have the opportunity to conduct testing with the CMS before the transition.

  • Practice makes perfect, and that is why the CMS is allowing the opportunity for you, or your clearinghouse, to conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). This testing will help ensure you can submit claims with the new ICD-10 codes. There is even a special testing period in June of 2015 that offers access to a real-time help desk, so ask your MAC for more information.

6. GEMs can help you get started.

  • The General Equivalence Mapping (GEM) tools convert data from ICD-9 to ICD-10 and vice versa. These free tools act as crosswalks between the two code sets and are designed to link concepts by mapping, without consideration of a patient medical record. Before you think you’ve discovered the easy way out, it is important to note that because GEMs are a mapping tool, they should not be used for help with coding. Basically, GEMs are a great stepping stone to get you to the unspecified code in ICD-10, but you’ll likely still need to use patient information to determine a more specific code once you get there.

7. ICD-10 codes are, and will remain, up-to-date.

  • ICD-10 codes have been updated annually since their creation and the CMS plans to continue to update them annually to keep up with the advances in medical technology. The first scheduled update for ICD-10 codes is October 1, 2016.

2 Actions to Take to get Your Practice Prepared

1. Update your practice management software.

  • Most practice management systems are either ICD-10 ready or will be in the near future, so be sure to contact your vendor to discuss any necessary steps you need to take on your end to ensure your system is up-to-date. If you’ve updated your practice management system, and you are documenting patient information correctly, your system should have the tools to point you in the right direction of the new code set.

2. Start using the 5010 claim format.

  • The 5010 claim format has been around for some time now and many practices have already made the switch, but if your practice hasn’t, now is the time. ICD-10 will only work with the 5010 format so make sure your practice is ready!

If you’re looking for more information surrounding the changes ICD-10 might bring for your practice, be sure to look at the CMS website!

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