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Why are we making the switch to ICD-10?
Do I have to make the change to ICD-10?

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Let’s look at the latter of the two questions that were posed, “Do I have to make the change to ICD-10?” first.  Yes.  Yes you do.  ICD-10’s are federally mandated.  This means unless you don’t like getting paid for anything that you do because you couldn’t get a single claim paid, yes you need to make the transition to ICD-10’s.

In reality, there are only two situations where ICD-10’s are not mandated, workers comp and third party payers.   Everyone else, tag, you’re it!

But few Americans like change.  Look at America’s non-use of the metric system for example.  When I was in first grade many moons ago, we were told that America would be in total use of that system by the time I graduated High School.  Now, I’m not going to show my age by revealing how long ago that was, but suffice it to say, it was a while back and we are still not using it as our primary system.  So why are they doing this to us now?  With the aging population and the recent adoption of the Affordable Care Act (Obamacare) don’t they think that providers are busy enough?

First, it is important to point out that the ICD-10’s are not a new phenomenon.  Countries such as Australia, Canada, France, South Africa and even China have been using this system for at least the last decade and the United Kingdom first mandated its use over 20 years ago in 1995!

The truth is, ICD-9’s run in this industry should be over for several different reasons.

Outdated Codes

ICD-9’s were developed in the 1970’s.  That means that they have been around for over 35 years.  Think back, what advancements have been made in medicine in the last 35 plus years?  Because of advances in technology and medical management, there are now countless procedures that have to be labeled as “other” in the ICD-9 world that will have formal codes to address each situation.


More Detailed Codes

It’s a lot to take in that we have to use 5 times as many codes on October 1st 2015 as we did on September 30th?  But the truth is medical coding will get easier with use. No longer will you fear the overuse the “other” code. This means that for almost every procedure or treatment that is done, similar to Apple’s last slogan, there is a code for that!  Was your patient injured when their water skis caught on fire?  Yes, there’s a code for that!  Walk into a lamppost…twice?  Yep, there’s a code for that!

And who hasn’t seen a patient that was injured in a spacecraft collision?  Yep, there’s even a code for that!  Use of the correct codes will greatly reduce the chances of being audited by individual insurance companies.


Better Data-Capturing capability

There are over 68,000 codes on the ICD-10 listing.  That means, like previously stated, there will be a code for almost everything.  CMS, insurance companies, and third party researchers will be able track data on best practices and treatments for injuries, diseases and medical management.  It is even possible that potential epidemic outbreaks can be stalled because of the exact nature of codes being inputted.


Better Reimbursement in the Future

There are a plethora of procedures and treatments that lack the data analysis capabilities needed for providers to be properly paid.  Many of the actions taken by physicians today, including all laser procedures and many of the current pain management treatments, were science fiction when the ICD-9’s were being created.  The new codes will allow for reimbursements to be paid at a more acceptable rate, which may mean more money in the pocket.


The Cost

Keep in mind, however that this does come at a premium.   That cost to you is new training for you and staff, new classes to become certified, and over 5 times as many codes as was accepted before.  These codes will go from a 3-5 numeric code with modifiers to an alphanumeric system of 5-7 digits plus up to a 3-digit modifier.  And, unlike last time, it is coming, ALL PHYSICIANS are expected to be ready for it.

The good news, you can arrange for a partner during this transitional phase.  Midwest Medical Billing, LLC has been preparing for the transition and has AAPC certified coders on hand to help you through this time and into the future.  We offer CODING and BILLING for all specialties and will fight to make sure every penny you earn is yours.  We also offer consulting and seminars to better help you in this transitional time.


Contact us today to see how partnering with us can make your future less stressful and more lucrative.


Quote of the day:

“Never too old, never too bad, never too late, never too sick to start from scratch once again.” –Bikram Choudhury







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