Running a small practice means you have to be very familiar with specific code sets to report medical diagnoses and inpatient procedures. The current system in use is called ICD-9 (International Classification of Diseases, 9th Edition), which continues to be required for every medical professional covered under the Health Insurance Portability Accountability Act (HIPAA).
But this code structure is due to be updated to ICD-10 by October 1, 2015, according to the U.S. Department of Health and Human Services (DHHS). Therefore, your office must be in compliance with the new rule at that time. If you have not implemented this revised code classification by the established deadline, your claims won’t be paid.
Why the Update Is Needed
Although it may inconvenience your business operations in the short-term, the amended codes will give you greater flexibility for the future. At present, ICD-9 is restricted to 3- to 5-digit code sets and that limits the data that can be associated with medical conditions and hospital in-patient procedures.
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Once the new system is in place, you will have a wider range of codes, allowing 3 to 7 digits instead. So you can be more descriptive in your patients’ records and experience better organization in your office as well. Since ICD-9 is now 30 years old, includes outdated terms and isn’t sufficient to address today’s medical practice needs, this update is designed to make processing claims much easier for you and your staff. Consider ICD-10 to be a welcome tool that will enable your medical practice to operate more smoothly so that you can devote more time to your patients.
Who Needs to Make the Transition
Because you’re covered under HIPAA, it’s essential to be aware that ICD-10 will directly affect your billing policies. It’s not just for medical professionals who submit Medicare or Medicaid claims. The only area that isn’t touched by the new system is CPT coding for outpatient procedures.
As a result, all healthcare providers, payers, clearinghouses and billing services must be prepared for the changeover to ICD-10 by the October 1st deadline. In addition, every electronic transaction has to employ Version 5010 standards, which have been mandatory since January 1, 2012.
Preparing Your Practice
The deadline for ICD-10 implementation is still months away. But now’s the time to begin preparations for this important update. Otherwise, you could fall behind and not be ready for the new system’s demands.
As a small practice, you may want to approach this transition by assessing the impact of the changeover on your office. Furthermore, think about devising a timeline and a budget to anticipate any expenses.
It’s also crucial that you check with your billing service, clearinghouse or practice management software vendor about any compliance schedules that are in place. Then you can coordinate with this component of your claims process and maintain an open communication throughout the upcoming transition.
While it may seem overwhelming to get ready for this update, you will have a better handle on any challenges if you start planning ahead. By developing an implementation strategy now, you won’t find yourself left behind when October 1st arrives.