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ICD-10 Implementation & Its Impact On Billing and Collections
ICD-10 Implementation & Its Impact On Billing and Collections
ICD-10 Implementation
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Specific Changes
• Diagnosis Codes (ICD-9 to ICD-10-CM)
▫ Goes from 5 positions (first one alphanumeric,
others numeric) to 7 positions, all alphanumeric
▫ From 13,000 existing codes to 68,000 existing
codes
▫ Much greater specificity
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LLC
Structure of ICD-10
13
Nachimson Advisors,
LLC
• Diabetes mellitus codes are expanded to include the classification of the diabetes and
the manifestation. The category for diabetes mellitus has been updated to reflect the
current clinical classification of diabetes and is no longer classified as
controlled/uncontrolled:
Nachimson Advisors,
LLC
• ICD-10-CM
▫ R31.0 Gross hematuria
▫ R31.1 Benign essential microscopic hematuria
▫ R31.2 Other microscopic hematuria
▫ R31.9 Hematuria, unspecified
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Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Specific Changes
• Enables laterality (right vs left designations)
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
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Nachimson Advisors,
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Nachimson Advisors,
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Nachimson Advisors,
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Nachimson Advisors,
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Provider Impacts
Documentation of diagnoses and procedures
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Provider Impacts
Coverage and payment
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Provider Impacts
Contracts with plans
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LLC
Provider Impacts
Billing and eligibility transactions
• Updated transactions include support for ICD-
10
• New codes mean more specificity
• How smooth the transition?
• Expect increased reject, denials, and pends as
both plans and providers get used to new codes
28
Nachimson Advisors,
LLC
Provider Impacts
Laboratory orders
• Will need specific ICD-10-CM codes for
laboratory orders
• Expect coverage changes
• Need to support the tests ordered
29
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
What to do now!
• This will happen at some time in the near future.
• Start the education process to determine how
this will impact your operations
• Start the budgeting process
• Identify key staff to begin
• Track progress of CMS and NCHS efforts
38
Nachimson Advisors,
LLC
Nachimson Advisors,
LLC
Questions?
Stanley Nachimson
Nachimson Advisors, LLC
www.nachimsonadvisors.com
Nachimson_advisors@verizon.net