How Will ICD-10 Affect Physician Reimbursement?
The International Classification of Disease (ICD) codes will be transitioning from ICD-9 to ICD-10 as of October 1, 2015, according to regulations originally presented on August 4, 2014, by the Department of Health and Human Services. This 1-year delay was designed to allow physicians and health plans more time to prepare for the new compliance date.1
The codes are used by physicians, nurses, health information managers and coders, researchers, policy-makers, health information technology workers, insurers, and patient organizations in order to classify various health and vital records and diseases.2
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The change is a controversial one, due in part to how instrumental ICD is in the reimbursement process for all health-care providers and physicians, and the timing of the change.
“While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time,” said Steven J. Stack, the President-elect of the American Medical Association.1
“The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so,” he said.1
In preparation for the switch, Medicare is conducting thorough end-to-end testing of claims from submission through receipt of remittance advice in January, April, and July 2015, which will provide physicians and healthcare providers with a better understanding of how their claims will be processed and paid.1
According to a fact sheet from the American Academy of Family Physicians (AAFP), the new ICD-10 codes will have a completely different structure compared to the ICD-9 codes. For example, while current ICD-9 codes are mainly numeric and consist of 5 digits, ICD-10 codes will be alphamumeric and contain 3 to 6 characters, though the process of searching for the correct code will remain the same.3
Further, the new codes will require that physicians include more specific details on certain conditions, such as the location of accidents or injury and the external circumstances.
While this will vary, examples of common primary care conditions requiring extra data include:
- Ulcers: The specific stage
- Asthma: Intermittent, mild persistent, moderate persistent, severe persistent
- Seizures: General or focal, what type, intractability
- Pregnancy: The specific trimester
- Fractures: Gustilo classification, fracture type
- Poisoning or toxic impact: The specific substance
The AAFP has published a timeline including steps, such as assessing, budgeting, planning, training, implementing, and monitoring to help physicians begin to make the transition to ICD-10. Visit their website for more guidance on how to prepare.3
-Michelle Canales Butcher
References:
1. ICD-10 code set to replace ICD-9. American Medical Association Web site. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page. Accessed April 22, 2015.
2. International Classification of Diseases (ICD). World Health Organization Web site. www.who.int/classifications/icd/en/. Accessed April 22, 2015.
3. FAQ on ICD-10. American Academy of Family Physicians Web site. www.aafp.org/practice-management/payment/coding/icd10faq.html#who. Accessed April 22, 2015.