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Don’t Be Scared, Be PREPARED for ICD-10 (Going Live Oct. 1, 2015)

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ICDBy Ronda Buhrmester and Dan Fedor, U.S. Rehab Well it's been a long time coming, with some delays, but currently it appears the transition to the ICD-10 diagnosis codes is a go on Oct 1, 2015. Don't be scared; be PREPARED! There is some confusion with this rollout because information is coming from many sources. At VGM, we are sifting through the information and sharing what’s relevant, which we hope reduces unnecessary confusion. We will keep on this and keep you updated as we progress towards Oct 1. Here are some Q and As to get the ball rolling ... Q: ICD-10 becomes effective Oct. 1, 2015. Does the ICD-10 date go by bill date or date of service? A: Goes by DOS. Q: Does this affect the HCPCS or CPT codes? A: No, only the diagnosis codes. Q: What is the difference between the ICD-9 and ICD-10 diagnosis codes? A: The ICD-10 codes are much more detailed, with the specific diagnosis and condition such as the location and/or position. Q: How many characters are in the ICD-10 codes? A: The ICD-10 codes can range from 3-7 characters that all start with a letter and are in chapters. Here are a few of the chapters:

  • E00-E89 Endocrine, Nutritional & Metabolic Diseases
  • G00-G99 Diseases of the Nervous System
  • J00-J99 Diseases of the Respiratory System
  • I00-I99 Diseases of the Circulatory System
  • K00-K94 Diseases of the Digestive System
  • L00-L99 Disease of the Skin and Subcutaneous Tissue
  • M00-M99 Diseases of the Musculoskeletal System
  • Q00-Q99 Congenital Malformations, Deformations, and Chromosomal Abnormalities
  • S00-T88 Injury, Poisoning & Certain Other Consequences
Here are some examples of ICD-9 to ICD-10 codes used for common DME items - Description ICD-9 ICD-10 OSA 327.23 G47.33 MS 340 G35 ALS 335.2 G12.21 CP 343.9 G80.9 COPD 496 J44.9 There will always be a minimum of three characters. The first three characters are the category, then the decimal. The next set of characters are the etiology, anatomic site, and/or severity. The last character is the extension. Q: Please confirm that claims with a “from” date of service prior to 10/1/15 are to be submitted with ICD-9 codes and claims with from dates of service 10/1/15 forward are to be submitted with ICD-10 codes? A: Yes, this is correct. Q: Can suppliers update their databases from ICD-9 to ICD-10, where it is a direct match and transmit the cross-walked codes on their claims? A: Yes, but many times there is not a one-to-one crosswalk. Sometimes one ICD-9 will crosswalk to several ICD-10 codes because the ICD-10 codes are more specific. Q: What do I need to be doing as a DMEPOS company?
  • Do not wait until Oct. 1, 2015, to work on the transition. Start now.
  • Work with your billing software and utilize training available.
  • Build a plan, choose a team and assign a project leader. Make sure to get training and have regular meetings to review progress.
  • Identify forms that may need changes to ICD-10.
  • Run reports find those codes that are going to be a 1:1 crosswalk and to find those codes that will not be a 1:1 crosswalk.
  • For those codes that are not a crosswalk, you will need to work with referral sources to get the correct code.
The future medical policies (LCDs) are available on each jurisdiction’s website. Even though not all policies are diagnosis-driven, we highly recommend reviewing these future policies. Do not wait to become familiar with the ICD-10 codes because these codes are more specific and more detailed than the ICD-9 codes. It’s vital to start the planning now, so come Oct. 1, you are not scared because you have prepared for ICD-10. Ronda Burhmester Reimbursement Specialist 888-665-6518 Ronda.buhrmester@vgm.com Dan Fedor Reimbursement Specialist 570-499-8459 Dan.Fedor@vgm.com

 

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