ICD10 Medical Coding

What’s next for ICD10 in 2016?

Most ICD-10 claims are being paid since the implementation of ICD-10 in October 2015. The reason for this is CMS made the claim submission standard more ‘relaxed’ and directed that claims be paid as long as the diagnosis code was in the correct “family.”  Beginning in October 2016, the ‘grace period’ for unspecified codes ends and CMS will begin more precise requirements for ICD-10 coding. This may mean a possible increase in claims rejections. Take steps now to make sure you are coding correctly!

MediSYS EHR offers excellent tools to drill-down quickly to the most specific ICD-10 code, called IMO (Intelligent Medical Objects). IMO is a clinical terminology-based documentation tool that is seamlessly integrated in MediSYS EHR and provides the Snomed equivalent using filters to quickly specify the needed diagnosis code.

ICD10 Gout

MediSYS is ‘ICD-10 Validated’ by Blue Cross Blue Shield of Alabama

MediSYS and ICD-10

ICD-10 Deadline was October 1st, 2015

Regardless of the ICD-10 deadline delay, MediSYS has stayed-the-course to be ready for the transition.  Currently, MediSYS has completed testing with all payers who are in the testing phase for ICD-10.  MediSYS successfully tested with Alabama Medicaid in 2013.  In addition, MediSYS has successfully tested ICD-10 medical coding with Change Healthcare (Emdeon), Navicure, Zirmed and Medicare.  MediSYS is also ‘ICD-10 Readiness Validated’  by Blue Cross Blue Shield of Alabama. At MediSYS, we always put our clients first!

To get ready, we recommended that providers do not delay preparation for ICD10.  Instead, providers should use this as an opportunity to convert their most frequently used ICD9 codes to ICD-10 and examine what changes are needed to their medical record documentation to support the new codes.  Doing this now, but no later that 6 months prior to October 2015, will ease the massive transition providers must make.  On the deadline, the expansion of the now 14,000 ICD9 codes to almost 70,000 ICD10 codes will occur.  Payers, Vendors, Clearinghouses, Physicians; anyone in the field of medicine will have to convert all on one day.  So make sure you are ready with your codes.  You can find a Top 50 codes by specialty laminated sheets at www.aapc.com/icd-10/

Going over the basics of ICD-10 Medical Coding:

  • Deadline: October 1, 2015
  • No effect on CPT codes
  • Required: ALL Providers and Payers

ICD-10 Changes to expect:

  • More codes – 69,853 (as compared to 14,315 with ICD-9)
  • 3-7 characters (as compared to 3-5 with ICD-9)
  • First character is Alpha (except ‘U’) (as compared to #, E, V with ICD-9)

Clinic Tips:

  • Update Forms: Superbill, etc.
  • Get list of your top diagnosis & remove unused codes
  • Dual-Code commonly used codes.
  • Focus on Improving Clinical Documentation
  • Prepare Billing & Coding Staff
  • Attend ICD-10 Medical Coding Webinars/Classes
  • Collect Resources – Available from CMS, BCBS, professional organizations, etc.
  • Update Code Book
  • Providers – Index for ICD-10 is still in alphabetical order

What about workers comp claims?

Non-covered entities, who are not covered by HIPAA, which includes Workers’ Compensation, are not required to implement the ICD-10 codes on October 1, 2015.  CMS will be working with non-covered entities to encourage them to participate in ICD-10 coding. Your practice should work with payers, such as workers’ comp, to determine how and when these they will be adopting ICD-10 and make sure you continue to use ICD-9 codes until these non-covered entities have implemented the changes.


* New – CMS Road to 10: The Small Practice’s Route to ICD-10:  http://www.roadto10.org/

ICD-10 Provider Resources: http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

Alabama Medicaid: http://medicaid.alabama.gov/news_detail.aspx?ID=8172

CMS Main Page: http://www.cms.gov/Medicare/Coding/ICD10/index.html

CMS Medicare Coverage: http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html

ICD-10 Quick Start Guide

CMS ICD-10 Videos: cms.gov/ICD-10