Practice Management Alert

Question: We are getting ready to start billing with the ICD-10 codes but have heard practices are getting denials. Should we be sending claims differently if we are starting to use ICD-10?

North Carolina Subscriber

Answer: You should not be billing with ICD-10 yet. The ICD-10 implementation is set for Oct. 1, 2013 and you should not be submitting claims to your payers using ICD-10 codes until then.  

The standard for diagnostic coding for services now through Sept. 30, 2013 is ICD-9.  Payers will not accept any other codes.  Then, on Oct. 1, 2013, the standard will become ICD-10.

Get ready: To prepare for ICD-10, you can shadow code your current claims to see if the documentation is sufficient to code for ICD-10 and to test your practice's ability to properly code using ICD-10. 

Keep in mind: On Oct. 1, 2013, if you are submitting a claim for a service in September 2013, you will still have to use ICD-9 since coding is based on the date of service, not the date of claim submission.

If the service is for Oc. 1 or after, you will have to use ICD-10. That means that for a period of time both code sets will be active. You will be doing A/R follow up activities with ICD-9 and ICD-10 after October of 2013. Plus, there may be some payers, like for motor vehicle insurance or workers' compensation that do not change over to ICD-10 because they are exempt.