ICD10 Codes – The Shocking Truth

October 2013 seems a long way away with little need to prepare now for the changes from ICD9 to ICD10 codes but I recently learned the shocking truth. The Healthcare Billing and Management Association held a conference in Boca Raton this month with a session attended by approximately 200 medical billers on the new ICD10 codes. Even though I have looked into the changes and even written on them, I was shocked to hear all that is really involved. We all need to start paying attention now.

My original questions revolved around whether all doctors will be expected to start using ICD10 codes on a specific day and will all the insurance companies be ready to accept them on that same day or will it be more of a transitional thing like the NPI numbers were.

My first surprise was that ICD10 codes are already in effect in all the rest of the world. Other countries have been using them for years. We are way behind the times with regard to the rest of the world.

My second surprise was that ICD9 codes are not just being expanded. ICD10 codes are totally different than ICD9 codes. We won’t just add another number and there aren’t just a few small changes. ICD10 codes will identify much more information about the visit than ICD9s do. ICD10 codes will contain an expansion of disease classification with greater specificity. They will be much more detailed and will help identify fraudulent billing practices. There will be no 1 to 1 crosswalk. This means that a 309.28 will not equal a A40258Z. You won’t take an ICD9 and turn it into an ICD10. They are completely different.

My next thought was how are my doctors going to learn all these codes? We bill many small specialty practices. Many of our chiropractors still do not understand the requirements by Medicare for the ICD9 codes. How are they ever going to get the ICD10 ones right? How are our psychiatrists, psychologists and social workers going to learn ICD10 coding? Most of these are single practitioners who work alone and do not hire a coder.

ICD10 coding will require more clinical information such as “did the patient use tobacco”, “did the patient use alcohol”, “which finger was cut”, “which part of the finger”, “was the nail damaged”. The new codes will contain alpha characters as well as numeric. The number 1 can mean 15 different things. It is estimated that it will require 24 – 40 hours of classroom education to understand the concepts of ICD10 coding.

Another consideration with the codes now using alpha characters as well as numeric is whether your software will allow you to use alpha characters. If you are using a web based software this won’t be a problem, but if you have a server based software, you will want to check with your vendor and make sure you will be able to submit alpha characters in diagnosis codes.

The speaker felt that unspecified codes may be a problem as insurance carriers have yet to tell us if they will pay on unspecified codes with the new changes. Pre-authorization policies will have to be rewritten. Workers comp is not subject to ICD10 changes so some companies say they will not process the ICD10 codes. For a period of time both ICD9 and ICD10 codes will be in effect. Does this sound confusing enough to the average biller yet?

Then came the bombshell. Insurance carriers are not ready for ICD10 codes and most of them won’t be ready. Many have announced that they will try to translate the ICD10 code back into an ICD9 code to pay the claim. This means doctors will be translating the ICD9 codes they are familiar with into a new unfamiliar ICD10 code and the insurance carriers will be translating this ICD10 code back into hopefully the same ICD9 code to pay the claim. I can only imagine the problems this will present.

As one of the speakers said “Hold onto your butts! It’s going to be a rough ride!”

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4 Responses to “ICD10 Codes – The Shocking Truth”

  1. Joe Corso Says:

    I have just completed Medical Office Specialist program at Ocean County College, am now a medical office specialist and certified billing coding specialist. But education is to continue. This is just entry level.

    What I did learn is the rest of the world is going into ICD 12 or 14 already. No one is even teaching the ICD 10 coding yet. We are so far behind, how do we catch up?

  2. Alice Scott Says:

    I agree Joe, once I realized how much the ICD10s have changed from the ICD9s, I wondered how our doctors will be able to code.

  3. Allison Says:

    Thank you so much for sharing your knowledge with all of us. The information is always pertinent and educational. Much appreciated.
    With Integrity, Allison

  4. mitchman3 Says:

    I wrote about ICD10 codes a few years back, so I knew the rest of the world was already using them. It’s not going to be easy, that’s for sure. However, I’m not surprised about the crosswalk approach; that’s the only way most insurance companies are going to have a clue as to how to pay the claims, and how most billing people will have to figure it all out.

    Heck, this could be a boon to consultants; I wouldn’t be mad at that.


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