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ICD-10 and payors

  1. Default ICD-10 and payors
    Medical Coding Books
    Will all other payors be required to transition over to ICD-10 by October 1, 2013 as well? Also, are they allowed to start using ICD-10 prior to the effective date?

  2. #2
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    All HIPAA entities will be required to accept ICD-10 CM for all visit date Oct 1, 2013 and forward, for visit date prior to Oct 1, 2013 all payers will continue to assign ICD-9 CM. No one is allowed to submit claims using ICD-10 CM codes prior to a visit date of Oct. 1 2013.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    No you cannot use ICD-10 prior to October 13, 2013. All insurance carriers are to use ICD-10 also except workers comp and auto. Those are the only two that I know of that are not required to use ICD-10.

  4. Question ICD-10 and HIPPA 5010
    How will these changes effect a small pediatric out patient rehabilitation clinic? Most of the training appears to MD and hospital related?
    Last edited by WEWhiting; 11-04-2011 at 07:48 AM.

  5. #5
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    ICD-10 CM is not really that much different from ICD-9 CM. IF you look at the guidelines you will find that they are very similar. There are a few issues ICD-10 CM has that affects all coders in all settings. so the training will be effective regardless of whether you attend MD or facility training. Now ICD-10 PCS is for the inpatient facility coding only so that will not apply to outpatient rehab. But any ICD-10 CM training will apply to your setting as well.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    There is going to be a period of time where we will be working with both sets. Anything on or after 10.1.13 will need to be submitted as ICD-10 but any follow up work being done on visits prior to 10.1.13 will still require ICD-9. Make sure your software is capable of handling both for at least a year after implementation.
    Also some of the payors I have spoken to have stated that they will role back all ICD-10 claims to ICD-9 internally and pay the claims based on their existing edits until such a time comes that they can develop (or revise) policies for 10. So although we may be submitting correctly existing edits at the payor level may deny claims for some time.

    CMS had something to say in their release last Wednesday about what we can expect from payors immediately after the conversion. It was a single sentence buried on the 29th page, yes I read every page, lol. They suggest that providers should secure a line of credit to cover operating costs while payors adjust to ICD-10. For me that's a huge red flag!!! It tells me that despite our efforts to as ready as possible CMS believes that nothing we do will be enough for the payors and that we should expect months of denials.
    Last edited by Peter Davidyock; 11-06-2011 at 03:43 AM.

  7. #7
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    TPontillo,

    Quote Originally Posted by tpontillo View Post
    No you cannot use ICD-10 prior to October 13, 2013. All insurance carriers are to use ICD-10 also except workers comp and auto. Those are the only two that I know of that are not required to use ICD-10.
    A couple of questions:
    1. Where do you get that 10-13-13 is the effective date for using ICD-10?
    2. Where do you get that w/c and auto are the only non-ICD-10 payers after the effective date of ICD-10? Isn't Medicaid another exclusion? What about secondary insurers?

    Just curious.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  8. #8
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    I am not sure where she got the 10/13/13 date it was probably a typo. But this is a HIPAA regulation and applies to all HIPAA entities which does include Medicaid and all commercial payers. But WC and auto are not HIPAA regulated

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    Thank you, Debra.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  10. #10
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    Lauderdale Lakes
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    The 10/13/13 was a typo, I meant 10/1/13

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