Claims Management News

Will the Move to ICD-10 Medical Coding Delay Claims Processing?

By Vera Gruessner

- The health insurance space is about to have a major transformation in medical coding that could potentially cause financial barriers and claims processing issues. If the transition to ICD-10 medical coding is not properly managed, a variety of concerns could lead to reimbursement difficulties and delays in claims processing.

ICD-10 Medical Coding

October 1 is the deadline for the move toward ICD-10 medical coding and health insurers will need to keep track of any issues to prevent major delays to reimbursement. With ICD-9 coding about to become a thing of the past, it is important to keep in mind that the sheer volume of codes is changing drastically since the ICD-10 medical coding set holds 70,000 codes – a significant increase from the 14,000 codes of ICD-9.

The Wall Street Journal reports that the cardiology field will have 845 codes for angioplasty to remember, dermatologists will have eight separate codes for acne, and gastroenterologists have to specify where a patient’s pain is located and what other symptoms are present. This should all lead to improved patient care and better outcomes across the healthcare industry.

At this point in time, health insurers as well as hospitals, private medical practices, and clinics have put in tremendous effort into preparing for the transition to ICD-10 medical coding. From training and staff education to implementing new systems and developing backup plans, the healthcare industry is as prepared as it will ever be for the move toward ICD-10 medical coding.

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  • There is still fear today that the new move could lead to twice as many claims denials or, at the very least, delay claims processing and cause financial hardships on medical facilities. However, it will take a few weeks to see whether the transition to ICD-10 has led to a delay in claims processing.

    “Any problems that crop up will be far more evident on Oct. 15 than Oct. 1, because it takes that long to process claims,” Dr. William Rogers, an emergency physician and the Center for Medicare and Medicaid Service’s ombudsman for the ICD-10 transition,  told the news source.

    The coding system is used by health insurers to determine whether services given to the patient were medical necessary and whether the healthcare providers should receive full reimbursement. Only time will tell whether the transition to the ICD-10 medical coding set will negatively affect reimbursement throughout the healthcare industry.

    The ICD-9 coding set is well-over thirty years old and the transition to the new one is well-warranted, as new medical innovations, diagnostics, and treatments have taken place over the last several decades.

    “ICD-9 has been the standard for coding since 1979. The transition to ICD-10 is a major upgrade to an antiquated coding system. This transition will increase the number of diagnostic codes to 69K, in an effort to better capture the specificity and complexity of illnesses and injuries with more accurate descriptions,” Ken Bradberry, Chief Technology Officer for Xerox Commercial Healthcare, told RevCycleIntelligence.com.

    “For providers, this will require a process change in documentation practices. It can also mean a deeper assessment of the patient in order to achieve the level of specificity needed for clinical documentation. For example, a femur fracture with ICD-9 required only 16 codes, but with ICD-10, that increases to 1,530 required codes. With this dramatic change, it's critical that providers do not code improper or incomplete ICD-10 codes, as this could lead to claims being denied and delays in service to the patient.”

    Updating the codes to include new diseases, symptoms, specifications, and diagnostics is key toward improving the quality of healthcare services throughout the nation. With the country moving toward value-based care, ICD-10 medical coding will give doctors the chance to illustrate their skill levels and receive appropriate reimbursement.

    “A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders,” Dr. William Rogers explained. “ICD-10 will give us the precision to do that.”