ICD-10 Compliance and Medical Billing

ICD-10 is the acronym for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision.  As of October 1, 2014, ICD-10 is scheduled to replace the current ICD-9 codes, and ICD-9 codes will no longer be accepted.  All HIPAA covered entities must make the change.  HIPAA covered entities include:  health care providers that are required to send or accept electronic transactions; clearing houses; and health plans.  HIPAA covered entities attempting to use ICD-9 codes on or after October 1, 2014 will find that their claims will be denied without payment. 

Iridium Suite medical billing software is already ICD-10 compliant.  Our software will utilize only ICD-10 codes on October 1, 2014 and thereafter.

ICD-10 system compliance has been entirely taken care of by Iridium Suite’s IT staff, removing the burden of compliance from our customers.  Perhaps most important, the ICD-10 upgrade has been provided to our clients at no additional charge.  Medical Business Systems will also ensure that our clearing house is compliant with the required changes.  Iridium Suite users will not have to manage any aspect of ICD-10 compliance as it relates to their medical billing system.

ICD-10 codes contain up to seven alpha-numeric characters while ICD-9 codes only contain up to 5 characters.  Each character represents a component that describes the medical treatment or procedure in detail.  There are 35 possible values for each character:  the digits 0-9 and all letters except the letter “U”. 

The expanded length of ICD-10 codes enables them to convey more specific information.  The system will be easy to expand and the codes’ structure makes them easier to analyze.  While there are approximately 13,000 ICD-9 codes, there will be more than 68,000 ICD-10 codes.

The improvements brought about by the change from ICD-9 to ICD-10 include:  the addition of information regarding ambulatory and managed care; expanded injury codes; combined diagnosis/symptom codes to better describe medical conditions; and greater specificity overall.  For example, the new ICD-10 codes will allow for increased detail related to a finger amputation procedure.  Under ICD-9, there is just one code for finger amputation regardless of the digit involved and the level of difficulty associated with the amputation.  With ICD-10, there are distinct codes for each finger and each section of each finger, which allows the insurance company to determine the proper payment to remit for the procedure.

In addition, the new ICD-10 codes facilitate the tracking of mortality rates in conjunction with the specific diagnosis.

Medical practices and medical billing services are encouraged to speak with their billing system providers right away to determine how their provider will handle the upcoming ICD-10 requirement.  To learn more about Iridium Suite’s preparedness for ICD-10 contact us or call 775-453-3193.