ICD-10 Is Coming! Is Your Office Ready?

Posted on May 22, 2015

ICD-10 Implementation & Transition Webinar!
Tuesday 05/26/2015 & Thursday 05/28/2015 7-9 PM CT
Tuition: $59.00 for each event.
Speaker: Monte Horne, DC

ICD-10 Is Coming October 1, 2015!

Are You & Your Office Ready?

According to the ACA it will take the average chiropractic office 3 months to prepare for transition! This is more than just a new code set. First, your documentation must change to support the more specific ICD-10 codes. Next, you will need software updates for your electronic health records & billing software. Then, you will need to communicate with your clearing house and major third party reimbursers. Staff training will be integral to a smooth transition. Finally, you will need to test, test, test!
Failure to plan NOW is planning to fail! According to the ACA there may be a 2-3 month delay in reimbursement following transition. Do you have a financial plan to bridge the gap?

Our ICD-10 program WILL prepare you & your office for this difficult transition!

05/26/15 7-9 PM CT
Monte Horne, DC
Coding & Documentation 306: ICD-10 for Chiropractic Practice (Part I)
2 Hours
-An introduction to ICD-10
-ICD-10 Implementation Guide for Chiropractic Practices
-Coding Guidelines
-Converting from ICD-9 to ICD-10
-Documentation for ICD-10

05/28/15 7-9 PM CT
Monte Horne, DC
Coding & Documentation 307: ICD-10 for Chiropractic Practice (Part II)
2 Hours
-An introduction to ICD-10
-ICD-10 Implementation Guide for Chiropractic Practices
-Coding Guidelines
-Converting from ICD-9 to ICD-10
-Documentation for ICD-10

Our Courses Are Sponsored By Parker University, State Board Approved, & PACE Approved!

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ICD-10 Frequently Asked Questions

Q. When will I be required to use ICD-10-CM?

A. On October 1, 2015 all providers will be required to report ICD-10 diagnosis codes on all claims with service dates of October 1st or later.


Q. Is the October 1, 2015 date flexible? 

A. The October 1, 2015 date is not flexible. All Health Insurance Portability and Accountability Act (HIPAA) covered entities MUST implement the new code set with dates of service that occur on or after October 1, 2015. 


Q. Will there be a grace period for the use of ICD-9 codes submitted after implementation of the new ICD-10 codes? How long after the October 1, 2015 ICD-10 compliance date may I continue to report and/or process ICD-9 codes?

A.  At this time, CMS has indicated there will not be a delay in implementation of ICD-10 and the cut off date for claims containing dates of service with ICD-9 codes will be September 30, 2015. Generally speaking, ICD-10 codes should be used for any date of service on or after the implementation date.  Dates of service prior to the implementation date should be billed separately with ICD-9 codes.  HOWEVER, each payer will determine their late filing requirements for standard transactions and ICD-10 does not require a change to these requirements. These deadline requirements vary among plans. Contact your payer for the current information regarding late filing for claims.



Q. Who is presently using ICD-10?

A. ICD-10 is already being used in a number of countries including: the United Kingdom, France, Germany, Australia, and Canada.


Q. If I’m a non-covered entity under HIPAA do I have to use ICD-10-CM?

A. Technically, no.  However, after ICD-10-CM is implemented, ICD-9-CM will no longer be maintained by the World Health Organization. Because of this, even non-covered entities may find that it is best to begin using ICD-10. The Centers for Medicare & Medicaid Services (CMS) are also going to work with non-covered entities to encourage their use of ICD-10. Even though ICD-10 may not be required of non-covered entities such as providers who do not bill electronically or workers’ compensation carriers, it may be mandated by state regulation. In addition, providers who do not bill insurance carriers may find that their patients turn in bills for reimbursement from their insurance company.  Continued use of ICD-9, a code set that will be outdated, may present significant problems for providers.


Q. I am a ‘cash only’ practice and do not contract with any payers. Do I still need to use ICD-10? 

A. While technically you do not have to do so under the HIPAA federal regulations, it is still a good idea to include ICD-10 codes on the bill you provide to your patient. The reason for this is that some patients may submit claims to their insurance company on their own behalf.   Under healthcare reform, there is a focus on accuracy of data so that data mining can occur for research purposes and for population health analyses. Uniform use of ICD?10 allows more detailed specificity and consistency in claims data analyses. 



Q. What is the difference between ICD-9 and ICD-10-CM?

A. ICD-10-CM codes provide greater detail in describing diagnoses. There are substantially more ICD-10 codes than ICD-9 codes.ICD-10-CM codes are longer and are comprised of 3-7 alpha or numeric digits. The first digit is alpha, the second is numeric and the following digits are either alpha or numeric. None of the alpha digits are case sensitive. Because of the increased size of the code, system changes will need to be made to accommodate ICD-10- CM codes. Use of ICD-10 involves much more than using a different set of codes.  More specificity is expressed in ICD-10 and the provider or coder must understand new nomenclature and how to select the most appropriate code within the ICD-10 rules.


Q. What are General Equivalence Mappings (GEMs)? As a doctor of chiropractic, will I be able to use the GEMs that are developed?

A. GEMs are reference mappings, to help the user to find a code which would be in the general vicinity of the correct code in ICD-10.  GEMs help with the challenge of translating the meaning of one code set to the other. Just like translating between languages, translating between coding systems does not necessarily yield an exact match. You may not be able to capture the full meaning of the original code because of underlying differences in the structure of the ICD-10 code. For this reason, it is essential for providers to only use GEMs as the first step in finding the most specific code that applies to their patient. It is important to understand that one must learn how to look up a code under ICD-10.  Using only the GEMs will likely lead to audits and other problems with claims submission. 


Q. I’ve heard there might be a code freeze for ICD codes. What is that?

A. Many vendors and organizations involved in coding requested that a “partial freeze” on adding any new ICD codes be implemented. Some were concerned that transitioning to a new version of ICD-10 coupled with the introduction of additional new diagnosis codes could be overwhelming for providers. A proposal was introduced which would allow for the last regular, annual updates to both ICD-9-CM and ICD-10 to be made on October 1, 2011.  There would then only be limited ICD-9 and ICD-10 updates for new technologies and diseases between October 1, 2013 to October 1, 2015. On October 1, 2016, regular updates to ICD-10 will begin. For more information click here


Q. Are the ICD-10 codes replacing Current Procedural Terminology (CPT) procedure coding? 

A. No, the change to ICD-10 diagnoses codes will not impact CPT coding for outpatient procedures. Although, clinics are encouraged to keep an eye out, every year on January 1st, for new, revised and deleted CPT codes; this should be a normal process in your clinic.


Q. What will happen if our clinic does not switch to ICD-10?

A. Claims that are submitted by HIPAA covered entities, without ICD-10 diagnosis after October 1, 2015 will not be processed. 


Q. What are some of the things I should include in my documentation because of ICD-10?

A. In general, you will need to include details such as laterality, level of subluxation or dysfunction. For conditions such as diabetes, type must be documented; asthma must document degree of persistence; an injury must document type, location (such as muscle or tendon, including separating strain from sprain), stage of care and external cause; ulcers must document what stage; headache must document type, persistence, and cause. 


Q. I hear that our clinic should be contacting our vendors, what is the reason? 

A. Any clearinghouses, billers and practice management companies should be contacted to determine whether they will be upgrading systems to accommodate ICD-10 and whether there will be any cost to the provider for upgrades. Providers should also obtain a timeline from these vendors to ensure that all updates will be made prior to October 1, 2015.


Q.  What benefits are there for Non-covered Entities to transition to ICD-10?

A.  According to AHIMA, there are several benefits for non-covered entities and notes that CMS plans to work with these organizations to encourage ICD-10 use.

Benefits: The increased detail in ICD-10 provides significant value to non-covered entities. For example, the expanded injury codes will be useful to automobile insurance and workers' compensation programs. Non-covered entities stand to achieve the same benefits of using more detailed, up-to-date code sets as covered entities, including better data for:

  • Measuring the quality, safety, and efficacy of care
  • Designing payment systems and processing claims for reimbursement
  • Conducting research, epidemiological studies, and clinical trials
  • Setting health policy
  • Operational and strategic planning and designing healthcare delivery systems
  • Monitoring resource utilization
  • Improving clinical, financial, and administrative performance
  • Preventing and detecting healthcare fraud and abuse
  • Tracking public health and risks

In addition, ICD-9-CM will no longer be maintained once ICD-10 is implemented; meaning the usefulness of the ICD-9-CM code set will rapidly decline. ICD-9-CM products and resources also will become increasingly difficult to obtain. Those non-covered entities that continue to use ICD-9-CM after the ICD-10 compliance date will compromise their ability to compare data with covered entities.



Q. Why the need for change?

A. The ICD-10 code set allows providers to report greater specificity and more detailed clinical information. This increased specificity will assist in public health surveillance and provide an increased ability to statistically measure health care services. ICD-10 also includes updated health care terminology and provides higher quality data for processing claims, making clinical decisions, designing payment systems and measuring care provided to patients.


Q. How will I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2015 to on or after 10/1/2015?

A. Many payers are planning to require claims with dates of service that span the October 1, 2015 implementation date to be split so that the services prior to 10/1/2015 will be billed separately and utilize ICD-9 codes; services on and after 10/1/2015 will then be billed separately and utilize ICD-10 codes. All clinics should check specific payer guidelines for processing claims for services that span the 10/1/2015 ICD-10 transition date.


Q. I am afraid that ICD-10, with its large number of codes, is going to be confusing to implement in my office. Is ICD-10 difficult to navigate?

A. Many believe that ICD-10 is more logically structured and is therefore much easier to use than ICD-9. ICD-10 is also currently being used by many doctors around the world without issue. As with any new system, it will take time to adjust, but it is a necessary change. To help with the transition from ICD-9 to ICD-10, General Equivalence Mappings (GEMs) will be available to assist in translating data from ICD-9-CM to ICD-10. 


Q.  Do I have to be using an EHR or electronic claims submission service in order to submit claims using ICD-10? 

A. Technically, no.  The method used to document or submit claims does not have any impact on the codes submitted on the claims.  However, a provider who submits electronic claims is a HIPAA covered entity and would be required to use ICD-10. 


Q. If ICD-10 is intended in part to increase the specificity reported for diagnoses, will I be able to use unspecified diagnosis codes after October 1, 2015?

A. Providers have to report the most accurate diagnosis codes available at the time of the service.  If a provider is not able to provide the most detailed level of specificity at the time the patient is seen, then an unspecified diagnosis code may be used.  However, providers should be aware that unspecified diagnosis codes may be flagged during claim adjudication and require the provider to submit documentation in order to justify the unspecified code.  Providers/coders/billers are strongly urged to contact the payer to determine their specific policy with regard to unspecified codes. It should also be noted that coding the symptoms the patient is experiencing (as opposed to the diagnosis) is also acceptable in some limited cases.


Q. Are personal injury, disability insurers and workers’ compensation companies required to implement ICD-10?  

A. These companies may do so, but are not required to.  They are not considered HIPAA covered entities and may choose to not adopt ICD-10 or may choose to do so at a date later than October 1, 2015.  



Q. Where can I obtain an ICD-10 manual? Will the information only be available online?

A. ICD-10-CM manuals can be purchased from a variety of sources. Check the ACA Store for information on how to purchase ChiroCode’s ICD-10 Coding for Chiropractic- Second Edition.


Q. I am just beginning the process of readying my office for the transition and am overwhelmed by the volume of information that must be reviewed. I am not sure where to begin. Does ACA have any information to help members understand ICD-10?

A. Yes, ACA has worked extensively over the last two years to build resources, with almost all of them being free to members. To get started, visit www.acatoday.org/ICD10.  There you will find an introduction to ICD-10. There is a free webinar, articles to bring you up to speed and other resources provided by outside organizations. You will also find Code It!, which  demonstrates ICD-10 in a hands-on practical way, a link to the ICD-10 Toolkit, which is our most comprehensive resource, and a free GEM code conversion tool. New resources will be added, so remember to check back.

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