ICD-10: Learn a new language

Monday, March 26, 2012

A. The International Classification of Diseases, 10th Edition (ICD-10) developed by the World Health Organization will replace the ICD-9 coding system, which, among other issues, did not allow enough characters to classify new diagnoses. The goal is to improve care delivery through more specific diagnoses that match healthcare payments to outcomes, and promote efficiencies in care documentation, claims processing and business intelligence. In the short term, this switch has the potential to increase costs and disrupt reimbursements.

The biggest implications for DMEPOS providers are increased training costs, improper qualification of new diagnosis, and increased audit risk. Patient intake and billing are the epicenter of risk. 

The key risk for intake and billing is interpreting and applying proper diagnosis code, and applying proper item codes for the product/therapy. Done correctly, the patient receives what they need, and the provider gets paid ASAP. Errors may result in denial, over/underpayment or delayed payment. Once a provider is associated with too many denials, audits can occur.

Intake and billing employees will, in effect, need to learn a new language. ICD-9 codes have been around for 30 years and today "misqualifying" diagnosis codes are the No. 1 reason for denials. Couple this with new usage policies, and the challenge is obvious. Employees will need ongoing training pre- and post-transition. 

System infrastructures will also need to be updated. ICD-9 codes are three to five characters long, while new codes are three to seven  characters. There will also be more alpha characters. Management systems that manage intake, billing and inventory must be updated. HME

Gregg Timmons is president and CEO of MedAct Software. Reach him at gtimmons@medactsoftware.com or 800-326-0314.