Our country was the last country in the world that has a truly modern healthcare system to adopt the ICD-10. The transition to ICD 10 codes, however, has been anything but easy, especially when we had to play catch up. There were several reasons as to why the change was absolutely necessary however. First of all, the ICD 9 was limited in how much information could be indicated. Secondly, the ICD 9 was 30 years old and therefore significantly outdated and inconsistent with the modern world. Lastly, it was no longer possible to create new codes, as its categories were full.
Transition To ICD 10 Codes Is Mandatory
Any procedures that are performed after October 1, 2014 have to be diagnosed using ICD 10. If a claim is not coded with ICD 10 after that date, it is not possible for the healthcare facility to get paid. Many payers have started to decline any ICD 9 codes after the deadline. The reason why the transition was hard, however, was because any procedures completed before that date had to be coded using ICD 9, or they won't get paid. Although this was the original idea, the transition was so complex that the date was pushed backwards by a year, meaning the cut off date became October 1, 2015.
The New Start Date
ICD 10 went fully into effect on October 1, 2015. All claims of service up to September 30, 2015 can still be coded using ICD 9. While this was confusing, people were happy to see that the CPT codes were not changed. That is because CPT is used for billing, whereas ICD 10 is used for diagnosis. The transition did not, in any way, affect CPT. ICD 10 PCS is used solely for inpatient hospital procedures.
ICD 10 Affects Everybody
ICD 10 affects everybody who is covered under the HIPAA. Some people believed that it would only affect Medicaid and Medicare claims, but that is not true. Hence, the ICD 10 transition also affected rehab therapists, all other types of providers, clearing houses, payers, and billing services. Simply put, anyone dealing with HIPAA has had to make the switch to ICD 10.
It was incredibly important that medical facilities prepared themselves properly for this. Of course, this is due to the fact that some 68,000 new codes suddenly needed to be implemented. This is why that those who started as early as possible have been the most successful in the transition. They consistently developed proper implementation strategies that looked at how the switch would impact the organization and when. They also had clear lines of communication with their billing services, vendors, and clearing house. Internal billing had to involve every relevant department, including finance, IT, clinical, and coding staff.
Transitions are never easy and this is true for the transition to ICD 10 codes. However, with proper planning and preparation, many health care systems have been able to implement it properly. The American Health Information Management Association has provided numerous documents and checklists that healthcare organizations can follow for implementation.