Orthopedic Coding Alert

If you’re feeling hesitant to adapt to ICD-10, it’s time to start planning.

With just six months left until use of ICD-10 codes is mandatory, there are still some practices that are feeling more defiant than compliant. If you remain opposed to the ICD-10 transition, CMS offers a stark reality in its recent website FAQs, letting you know that you simply won’t be able to collect from the program if you turn your back on the new coding system.

If you don’t switch to ICD-10, your claim “cannot be processed,” the agency bluntly explains. Of course, this means that any services you submit to Medicare, Medicaid or any other payer covered by the HIPAA laws will have to transition to ICD-10 or else they won’t get reimbursed for their charges.

Myth: Some practices believe that they are exempt from ICD-10 if they don’t participate with Medicare, but that is simply not the case. The transition “includes providers and payers who do not deal with Medicare claims,” CMS says on its site.

In addition, some providers believe that they can avoid ICD-10 codes because they don’t deal with any insurers, and accept cash only for their services. This could still cause an issue down the road, because many patients subsequently bill their insurers for the services independently for reimbursement. To do this, they would need to provide an accurate CPT and ICD-10 code after Oct. 1.

Bottom line: If you haven’t started transitioning to ICD-10, you shouldn’t waste another day—it’s time to ensure that your staff members and practitioners are trained on how to use the new diagnosis coding system. In addition, ensure that your software and forms are all ICD-10 compliant so you don’t face denials this October when the new system goes into effect.