A prior authorization was received in July 2015 for rental equipment for six months. The prior authorization will not need to be resubmitted with ICD-10 codes for dates of service on and after October 1, 2015. Claims for dates of service of September 30, 2015 and before will need to be submitted with ICD-9 codes. Claims for dates of service on and after October 1, 2015 will need to be submitted with ICD-10 codes.
ICD-9-CM is running out of code capacity to expand and keep up with advances in technology. Most of the categories contained in ICD-9-CM are completely full with no room for expansion. Another reason for the switch is the growing need for precise quality data.
Therefore, claims that do not use ICD-10 diagnosis and inpatient procedure codes will not be processed and reimbursed.
Further, mortality coding (death certificates) in the U.S. moved to ICD-10 in 1999 so the U.S. cannot directly compare morbidity diagnosis data to state and national mortality data.
Since insurance companies adhere to the CMS guidelines, ICD 10 is the national standard. The reason why ICD 10 had a slow nationwide implementation is that of technical and political complications surrounding the issue. This is why its implementation was been delayed a number of times.
On October 1, 2013, the ICD-9 code sets will be replaced by ICD-10 code sets. The U.S. Department of Health and Human Services issued a final rule on January 16, 2009, adopting ICD-10-CM (clinical modifier) and ICD-10-PCS (procedure coding) system.
Like ICD-9-CM codes, ICD-10-CM/PCS codes will be updated every year via the ICD-10-CM/PCS Coordination and Maintenance Committee.
ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after 10/1/2015.
Currently, the U.S. is the only industrialized nation still utilizing ICD-9-CM codes for morbidity data, though we have already transitioned to ICD-10 for mortality.
Each yearEach year new, changed and deleted codes are released and become effective on October 1st for ICD-10-CM/PCS and January 1st for CPT and HCPCS code sets. Also code updates are issued each quarter throughout the year.
Your healthcare provider may be able to change the diagnosis code to one that gives you the coverage you need. If ICD-10 coding is not the reason for the billing issue, you may need to make an appeal with your insurance company.
As stated in the FY 2016 IPPS/LTCH PPS final rule (80 FR 49388), the GEMs have been updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process and will continue to be updated for approximately 3 years after ICD-10 is implemented.
The ICD-10 implementation date is October 1, 2015.
ICD-9-CM diagnosis codes are used by most providers, except dentists (unless the patient is dually eligible) and will be replaced by ICD-10-CM. ICD-9-CM procedure codes are only used in inpatient settings. ICD-10-Procedure Coding System (PCS) will replace volume 3 of the ICD-9-CM for inpatient procedure codes.
The purpose of the revision was to expand the content, purpose, and scope of the system and to include ambulatory care services, increase clinical detail, capture risk factors in primary care, include emergent diseases, and group diagnoses for epidemiological purposes.
ICD-9 uses mostly numeric codes with only occasional E and V alphanumeric codes. Plus, only three-, four- and five-digit codes are valid. ICD-10 uses entirely alphanumeric codes and has valid codes of up to seven digits.
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) implement ICD-10 for medical coding.
The most significant change between ICD-9 and ICD-10 is the number of new codes. There are more than 65,000 of them which are used to more precisely describe different illnesses and ailments, as well as treatments for them.
Failing to comply with the switch from ICD-9 to ICD-10 will be dangerous. While some payers might actually still want to see ICD-9 codes as well after 10/01/15, indications are that at least CMS will definitely “hard code” over to ICD-10 after 09/30/15 which could lead to mass denials of improperly coded claims.
The ICD 9 was ratified in 1975 at the WHO conference and for a long time, was the basis on which the American healthcare payments are based. ICD 9 has been stable which explains why a slew of other practices and standards developed around it.
The reason why ICD 10 had a slow nationwide implementation is that of technical and political complications surrounding the issue. This is why its implementation was been delayed a number of times.
ICD 9 is the ninth revision and was used worldwide, with countries like the US having their own implementation.
In 2008, an announcement from CMS stated that the US would now start using the ICD 10 CM, which is the American version of the ICD 10 implementation. Since insurance companies adhere to the CMS guidelines, ICD 10 is the national standard.