Thirty days has September—and so has your clinic to prepare for ICD-10. Just one month from now, you’ll have to start using ICD-10 codes on most claims with dates of service on or after October 1, 2015. Did you see I wrote, “most”? That’s not a typo. The reason I can’t say “all” is because not all payers are switching to ICD-10. That means you’ll have to be bi-code-lingual (so don’t purge your brain of all ICD-9 knowledge). Here’s how it works:
Ace the Test
Dual coding is a great way to get your practice prepared for ICD-10. As you test ICD-10 within your clinic, dual coding allows you to assess how the switch might impact your practice in terms of productivity, speed and size of payment, depth of documentation, and denial management.
Check the Calendar
Let me be clear: While you can dual code on the same claim in a pre-switch testing environment, following the transition, you can’t include codes from both code sets on the same claims. In fact, if you submit both ICD-9 and ICD-10 codes on the same claim for dates of service on or after October 1, they could be denied.
Here’s the deal:
- Claims for dates of service on or before September 30 should contain only ICD-9 codes.
- Claims for dates of service on or after October 1 should contain only ICD-10 codes.
For more information on how to handle this 48-hour period, check out this blog post.
Blast from the Past
But wait, what about those pesky workers’ comp or auto insurance carriers? These folks aren’t HIPAA-covered entities, and thus, they aren’t required to transition to ICD-10. But like Toyota, CMS is moving forward. The organization has been pretty clear about its intent to let ICD-9 ride off into the sunset—and to convert all payers to ICD-10: “Because ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in non-covered entities’ best interest to use the new coding system.” So, while some nontraditional payers may continue using ICD-9, others are making the transition to ICD-10. Not sure which of your payers are sticking with ICD-9? Unfortunately, the only way to know for sure is to call each payer and verify.
Split the Bill
Sometimes, you’ll see patients whose primary and secondary insurances require different code sets. In these cases, because you should include only ICD-9 codes on claims for payers who did not make the switch to ICD-10, you’ll need to split the claim and send each piece to the appropriate payer. Just be sure to check with these payers first to ensure you follow their claim splitting specifications. Otherwise, you run the risk of claim rejection.
While dual coding may not double your payments or double your fun, it will be necessary for some practices. So, make sure you know how and when to double-down or split your code sets—and make sure your vendors and payers understand these processes, too (which they should). Looking for more ICD-10 resources? Check out ICD10forPT.com, the Ultimate ICD-10 FAQ post, and our Guide to ICD-10 Transition Day.