For law enforcement officials, the 48 hours immediately following a crime are the most crucial. Why? Because if they haven’t found any leads, identified any suspects, or made any arrests by the time the two-day clock expires, their chances of cracking the case—and, in some cases, saving lives—dwindle significantly. And while ICD-10 isn’t exactly a life-or-death situation, those HIPAA-covered providers making the switch will be up against a similar make-it-or-break-it timeframe. The only difference—besides the whole crime thing—is that their preeminent 48 will occur in two distinct 24-hour chunks: September 30 and October 1. If you’re making the switch to ICD-10 this fall, here are your most important to-dos for these oh-so-critical dates:

PT Billing Secrets: 5 Things Payers Don’t Want You to Know - Regular BannerPT Billing Secrets: 5 Things Payers Don’t Want You to Know - Small Banner

September 30

  • Make sure you’ve identified all of the active cases that will span the transition and have found the appropriate ICD-10 code for each one of those patients.
  • If you use WebPT, you can get a head start on this process now. Simply use our ICD-10 code picker to select the most accurate diagnosis code for a particular patient. Then, save that code as a chart note for future access. (That way, it won’t appear on your pre-October 1 finalized notes or flow through to your billing.)
  • Finalize all notes for dates of service on or before this day (September 30) before the clock strikes midnight. The date of service on a claim dictates the type of diagnosis code it should contain (e.g., ICD-9 or ICD-10), and if you attempt to finalize notes containing ICD-9 codes after ICD-10 goes into effect, things could get messy. So, save yourself the headaches and get all caught up prior to October 1.
    • Keep in mind that ICD-9 codes and ICD-10 codes cannot appear together on the same claim. Otherwise, the claim will not process correctly, and payment will be denied. This is true for both current claims (i.e., pre-transition claims) as well as those submitted after the October 1 switch.    

October 1

  • Start adding—and saving—ICD-10 codes to all new notes.
  • If you are creating a new daily note for an active patient, simply add the correct ICD-10 code. There’s no need to complete a progress note or re-evaluation for the sole purpose of adding an ICD-10 code.
  • For Medicare or other insurances requiring plan of care certification, changing a patient’s ICD-10 code does not warrant a re-certification. You only need to obtain a physician signature if:
    • you change the diagnosis itself—in other words, you determine the patient has an entirely different injury or condition—rather than merely updating the diagnosis code to its ICD-10 equivalent, or
    • you make a significant change to the patient’s actual plan of care.
  • As I mentioned in the previous section, you cannot submit both ICD-9 codes and ICD-10 codes on the same claim. However, within WebPT, even if you have both ICD-9 and ICD-10 codes saved to a particular case, only the ICD-10 codes will appear on your finalized notes once the transition goes into effect.
  • Keep in mind that there are still some cases in which you’ll need to use ICD-9 codes after October 1. For example, non-HIPAA covered payers—including workers’ compensation and auto insurances—are not required to switch to ICD-10. Thus, they may continue to use ICD-9, which means you would need to use ICD-9 codes for those payers only.
    • Be sure to check with all of your nontraditional payers to verify whether they plan to make the switch on October 1. (On a side note, we've determined that the majority of workers' comp carriers plan to make the transition.)
    • WebPT will retain its ICD-9 selection functionality to accommodate those payers that choose not to use ICD-10. Members will simply designate ICD-9 as the default diagnosis coding set at the insurance level.
  • Remember that in some instances involving non-HIPAA-covered payers (e.g., auto insurances), patients have commercial insurances (e.g., Blue Cross Blue Shield) as secondary payers. In such cases, once the patient has exhausted his or her primary benefits, you would begin submitting claims to the secondary payer. And because the secondary payer likely will be using ICD-10, you must submit ICD-10 codes for any claims that go to the secondary insurance for payment.
    • For that reason, it’s a good idea to document these patients’ ICD-9 and ICD-10 codes from the get-go. For WebPT users, that means entering all of a patient’s insurances—primary, secondary, and even tertiary—into the system at the patient’s initial visit. That way, WebPT will prompt you to enter both ICD-9 and ICD-10 codes at the outset of treatment, making for a smooth transition to a patient’s secondary (or tertiary, if applicable) insurance once he or she has exhausted the primary benefits.

With a solid game plan, your clinic’s transition to ICD-10 shouldn’t be nearly as suspenseful—or dramatic—as an episode of The First 48. But, like a good detective, you’ll need to use all of the resources available to you to emerge successful. On that note, be sure to check out our Crunch-Time Guide to ICD-10 and our ICD-10 Bootcamp webinar. Still have questions about the switch? Leave ’em in the comment section below, and we’ll handle the investigation.  

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