ICD-10 Transitions Smoothly: Tips to Avoid Related Audits

Posted on in Billing/Reimbursement, Service Solutions

By Dorothy de Souza Guedes, VGM Education

After months – really, years – of preparation and dread, it appears the transition from ICD-9 to ICD-10 is going smoothly. Ronda Buhrmester, reimbursement specialist, VGM & Associates, said she hasn’t heard of any issues with ICD-10 since the October 1 implementation date. But that’s what she expected.

Not everyone was as optimistic: 70 percent of respondents said they expected some disruption in cash flow after the October 1 start date, according to a fall HME NewsPoll.

To explain, CMS had instituted October 1 as the deadline for health care providers, vendors, and payers covered by HIPAA regulations to begin using ICD-10, which is the most current version of International Classification of Diseases codes, a standardized system for documenting diagnoses.

There was Y2K-like panic as health care employees trained and systems were adapted to expand from 13,000 codes to 68,000. To ease the transition, Medicare assured physicians that claims would not be audited solely due to ICD-10 code errors as long as the code used is within the correct diagnostic family of codes. 

For the time being, Buhrmester doesn’t see any reason for audits specifically on ICD-10 coding. To best ensure this doesn’t happen, Buhrmester recommends the following:

  • Follow the medical policies and related articles to make sure you are using the correct ICD-10 codes. While not all policies are diagnosis driven, it’s important to make sure to use the correct code.
  • Suppliers do need to make sure to watch the date of service (DOS) because that is how the ICD coding is reflected.  For DOS before October 1, 2015, claims need to be submitted with ICD-9 codes.  For DOS on or after October 1, 2015, need to have ICD-10 codes.
  • Suppliers cannot do dual coding. Make sure to watch the DOS to ensure suppliers have appropriately coded so payments can be made timely.

If anything does change related to ICD-10-related audits, the Reimbursement Team will be on top of it and will let members know.

For Billing and Reimbursement information, contact the Reimbursement Team.