Wiki Outpatient orders after Oct 1

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bobbiehamner

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All,

Does anyone know for certain what will be required on outpatient orders when ICD10 is implemented? If the patient comes for a mammogram on October 2 and her physician order has a code of V76.12, will I be allowed to just code with the ICD10 equivalent or do I need to have the physician give me a new order with either an ICD10 code on it or a written diagnosis?

I've had conflicting information given to me on this and I am desperate to find out so I can stop my physicians from putting ICD9 codes on 6month follow up mammograms etc., and start putting ICD10 codes on those.
 
that is a great question- my thought process on this is if the icd 9 code can be crosswalked into a matching icd 10 code (by description) then you should not have to get an updated order. But 90% of the time this will not be the case because of the specificity of icd 10. Interested in hearing other opinions and/or AMA/CMS proof....
 
Why am I feeling I read somewhere that any SERVICE performed before Oct 1st has to be I-9 and on and after Oct 1st I-10. I can't remember the article or link to it. But I do remember it having an example.
 
that is not the actual question being asked. Any service billed with a DOS of 10/1/15 and forward must have valid ICD 10 code(s) on the claim. She is asking if the actual "order", whether electronic or written, for the medical service needs to have the actual icd 10 code written on it or can it have the icd 9 code on it.
 
back "in the day" the provider would simply write out the actual diagnosis, not the icd 9 code on the order. Thinking on this all day, I have not come across a mandate in my research on what will be required this fall....
 
I talked with a woman named Wendy yesterday at AAPC and she told me that if the outpatient order had an ICD9 code written on it that I would have to get a new order if the date is Oct 1 or later.

I hate to doubt anyone working at AAPC, but I want to see something in writing if at all possible. Does anyone have any links I could possibly check out??
 
The facility rendering the service (lab, rad, etc.) after 10/1 needs the ICD-10 code. Those services are often coded off just the order, so the ICD-10 code will need to be on there. Facility outpatient coders won't have time to translate for you, and for those organizations with CAC, it will take additional manual work to check the translation provided by the coding system. Do all coders everywhere a favor and plan to have ICD-10 codes on your orders, please.

Our organization has notified all referring providers (and employed providers as well) that all orders for diagnostics and procedures scheduled 10/1/15 or later are required to include the ICD-10 code. If it's not on there, we will call you, or we may not be able to see the patient. The code should be present; not just the language, because when administrative staff (not coders) check for medical necessity, they need the ICD-10 code, because they cannot translate from the language. That's another reason that I-9 codes cannot be used/translated from ICD-10.

The mandate (and it's in writing) is that we all use ICD-10 in all diagnosis reporting (and procedural reporting for inpatient surgeries) after 10/1. Not just on claims, but in EHRs, on orders, on referrals, and with pre-certifications. Not doing so will slow things down and make it difficult for codersand billers alike.
 
thinking on this topic more, I feel it all boils down to higher specificity and it more than likely will be a requirement to have the icd 10 code on the order....
For example if a dr wrote an order for a RT leg xray and wrote "729.5 pain in limb" on the order; fast forward to Oct 1st... the pt goes for the xray. Well, if you look up pain in limb in icd-10 it will then be a higher specificity... lower or upper, then the specific area of each. It is simply accurate ICD-10 coding at this point and I don't believe the AMA would have to create a separate policy or rule. Just my thoughts.
 
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