Prepare for Dual Billing in ICD-10

Our code sets are mandated by HIPAA; however, there are entities not mandated under HIPAA, such as workers’ compensation. Wise billers should understand the panels on which they’re participating and if those panels will be making the transition to ICD-10-CM, or if they will still require the use of ICD-9-CM codes. The entities not mandated to make the switch could cause administrative nightmares for all of us.

Consider this scenario:
A patient was traveling for work. She fell on ice in the parking lot of the hotel where she was staying, breaking her ankle and wrist. Under this scenario, there are three plausible billing alternatives as to who might be held liable: the hotel, workers’ compensation, or her personal health plan. Either way, it takes weeks for determinations and initially the personal health plan is billed. Six weeks later it is determined that workers’ compensation will cover the accident. In the meantime, many bills have been submitted for surgeries, medications, DME, and therapy.

In our ICD-9-CM environment, we would just need to switch the carrier name on the claim, add a few details and submit with our notes. However, after October 1, 2013 this could all change. If you participate with a panel that does not make the switch, not only will you have to change the carrier, but the claim will require recoding as well, which could mean backing out your claim, messing up your A/R and your financial data, not to mention the time and effort spent recoding.

Billers will need a good solid education of both code sets and nuances like this in ICD-10. Working with panels early to determine where they stand on making the transition to ICD-10 will help you make informed decisions on which panels you want to remain. Dual billing in both systems ongoing will pose administrative nightmares for practices and careful preparation every step of the way will assist you in successful ICD-10 implementation.

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