So… a guy walks into a lamppost… and it turns out there’s an ICD-10 code to describe his encounter: W22.02XA! Would you even admit that to the doctor? I did that once as a teen and would never tell a soul. You can read a WSJ article that goes into humorous detail on the subject here.
I decided it was time to discuss ICD-10 after Karen attended a seminar on the subject this past weekend and one of the tidbits they provided seemed incorrect. (It was.) So, what do you (and by “you” I mean small business health care providers) absolutely need to know about ICD-10? Here are the basics:
For claim submission
- Any services dated on or after October 1st, 2015 must be submitted with ICD-10 codes.
- Any services dated before October 1st – even if you submit the claim after October 1st – must use ICD-9 codes.
- You absolutely cannot use both types of ICD code on a single claim – so make sure you handle September 30th the same way you’d handle December 31st – everything gets billed.
- Though this change is mandated by HIPAA, some non-HIPAA covered entities like Workers’ Compensation agencies have made it clear that they won’t (or don’t intend to) be ready by 10/1/2015. Check either directly or through your state association to learn whether you’re affected as we get closer to the deadline.
ICD-9 vs. ICD-10
- ICD-10 codes are much more specific, and there are many, many more of them. So, if you manage to walk into a wall instead of a lamppost, yes, there’s a code for that: W22.01XA.
- You generally won’t find a 1:1 correspondence between ICD-9 & ICD-10 codes. There are websites where you can look up both codes and descriptions. And there are some that attempt to provide a crosswalk from ICD-9 to ICD-10 – but I would use those (here’s an example) as a tool to help locate more precise codes.
- Laterality (side of the body affected) has been added to relevant ICD-10 codes. So, the code you use may inherently define left or right.
- Another difference relates to episode of care. Whereas an ICD-9 code remains the same over multiple doctor visits, ICD-10 codes may change if it’s an injury or there’s an external cause. For example, a patient with a sprained ankle may return for re-evaluation to ensure the injury is healing properly. In the lamppost example above, the ICD-10 code would likely change to W22.02XD. The “A” (W22.02XA) stands for “initial” encounter (but “acute phase of injury” would be an appropriate way to think of it). The “D” stands for “subsequent” encounter. In 2015, “A” was clarified with regard to chiropractic care to refer to “acute,” and may to be used for all/multiple visits.
- Injuries are now grouped by anatomical site rather than injury type.
Dr. Karen Walters, DC, FACC discusses everything you need to know about ICD-10 in a 60 minute video that you can watch here.
“I just want to let you know how much I appreciate the ease of transition to ICD-10 with ECLIPSE. The “ICD-9 to ICD-10 comparable” option while entering diagnoses into a patient’s file is seamless. While most other offices are stressing, we will be able to continue along, “business as usual” come October 1st. Thank you.” — Dr. Michael Goldstein, D.C.
ECLIPSE is ready for ICD-10 now. ICD-9 & ICD-10 codes can be displayed together or separately by selecting an appropriate index. (There are separate indexes for ICD-9, ICD-10 and a crosswalk from ICD-9 to ICD-10.) We have prepared categorized ICD-10 databases for import – which include ICD-9 comparable codes where appropriate – and/or you can enter ICD-10 codes directly. These ICD-10 codes can be imported directly to your existing ICD databases and are available in the same two flavors we have always provided: everything or chiropractic specific. The chiropractic table has been carefully categorized by our team of D.C.’s to make it even easier to quickly locate the code you need. ECLIPSE users can review their 1/16/2014 & 7/16/2014 README entries for more thorough information.
This blog entry has been edited to reflect Congressional delay of ICD-10 from 10/1/2014 to 10/1/2015.