(Do You Need to Maintain Both Code Sets in Your Practice – Yes)
Even though everyone will be using ICD-10 codes after Oct. 1, 2014 if they want to get paid, clinicians won’t quite be finished with ICD-9. Patient records prior to ICD-10 implementation must be transitioned to the new coding system. There will be coding, form and procedural changes and there are sure to be glitches along the way. With forethought, planning and understanding, the changeover can proceed easier than many might anticipate.
Clinicians and billers will have new codes to use and new standards they must implement to adhere to HIPAA regulations. Multiple changes will take place over a very short time that will be stressful. There are strategies that can be used to accomplish all the target goals that don’t require an inordinate amount of effort, excessive overtime, and maintains HIPAA compliance.
For the smoothest transition, clinicians will need patient demographic information and the means to access it at will as they make the change from their old methods to the new EMR systems capable of handling all the new codes. To maintain HIPAA compliance, sensitive data can be stored on-site or in the cloud, providing that necessary security measures are in place.
All new patient information will be coded using ICD-10. Importing ICD-9 into the data into the new coding format for existing patients will take some time, but clinicians will find that as information is transferred and existing patients continue their care, overlaps will become apparent. Practice owners will need to maintain both coding systems for a time to ensure the complete transfer of patient data.
To facilitate the initiation of ICD-10, some EMRs have automatic crosswalks that will convert the coding. To ensure compliance, it’s essential that clinicians contact the clearinghouses and payers they work with and run sufficient testing to make sure all systems can communicate with each other. Each practice should make an effort to practice with converting ICD-9 to ICD-10 to familiarize themselves with its nuances before the official implementation date.
HIPAA version 5010 is the new standard for conducting electronic transactions to ensure patient privacy is maintained. It provides a platform for the use of ICD-10 coding. Practices and billers must implement the new HIPAA 5010 standards before ICD-10 codes can be utilized.
The upgrade to version 5010 was essential, as the old systems couldn’t use or accommodate the greatly expanded code set. HIPPA 5010 applies to “covered entities” that includes payers, providers, clearinghouses and health plan carriers. They all must upgrade to the new standards if they submit claims for reimbursement, transmit patient information, track claim status and verify coverage eligibility.
Clinicians should be aware that there are a couple of potential exceptions when the use of ICD-9 codes may still apply. Those are Workers Compensation and personal injury claims. The Affordable Health Care Act regulations continue to evolve and future legislation may change to encompass those two entities under ICD-10 coding.
The use of both coding systems allows practices to test and troubleshoot any intercommunication problems with payers and providers within its network. The testing process can identify areas where clinicians may need more training in appropriate documentation and provides valuable coding practice for clinicians and billers.