ICD-10 rush hour: What you need to do on transition day

Nina Keller, Digital Marketing Executive, CureMD
Nina Keller, Digital Marketing Executive, CureMD

As I type these words there are only 20 days until October 1st, AKA, ICD-10 transition day. Most people in the healthcare industry are wondering what that day will be like. What will happen? What will they have to do?

Our suggestion would be if you’re the praying kind – pray. If you have a lucky talisman, you may want to rub it or give it a shake that day.

Will October 1st be a bit like Y2K? Remember how we were all essentially preparing for Armageddon and then nothing really happened, it was sort of a regular, quiet day? Our best guess is that ICD-10 transition day will be something in between a regular day at the office and Armageddon.

Will we or won’t we say “I do” to ICD-10?

The history of the ICD-10 transition is a bit like a love story between a dysfunctional couple: the guy proposed years ago, she said yes, and the couple announced to the world they were getting married only to postpone the wedding numerous times.

Back in August of 2008, the Department of Health and Human Services (HHS) proposed that the U.S. healthcare industry switch over to the ICD-10 coding set (which pretty much every other developed country in the world had already done years before). In 2009, HHS officially ruled ICD-10 would be the new national coding set and set a date for the big day as October 1st, 2013. Then someone got cold feet and the date was pushed to October 1st 2014. Then came more fighting and crying and 2014 became 2015.

After this on-again-off-again relationship, many are still wondering (perhaps even placing bets in office pools around the country) whether the transition will be called off once again. Our best guess is, it won’t be called off and October 1st, 2015 will officially be ICD-10 transition day.

Just like there are important things to do on your big wedding day (find the rings that were in your pocket a minute ago and determine who should sit next to cousin Shirley who likes her Mai Tai’s and spits while she talks), there are some key things to do on ICD-10 transition day:

Begin utilizing the new codes

If you are billing for services on or before September 30th, you will need to use ICD-9 codes, but for services provided on October 1st you will officially need to start using the new ICD-10 code set.

No need for re-evaluation

When creating new daily notes for patients that are currently active you do not need to re-evaluate just to add an ICD-10 code, simply add the correct code to their chart.

Care certification requirements and physician authorizations

Medicare and other payers who require a plan of care certification and that you change a patient’s ICD-10 will NOT require you to go through an entire re-certification process. And you will only need to ask for a physician’s signature if the diagnosis itself is changed or if you make a significant change to the patient’s actual plan of care.

Non-HIPAA-covered payers

To make things even more complicated, there may be instances on and after October 1st where you will still need to use the old ICD-9 codes (grrrr, frustrating, isn’t it?). Even if you are submitting a claim on October 1st but the services were provided in September, you will still need to use the ICD-9 codes.

Also, there are non-HIPAA covered payers (workers’ comp and auto insurance companies) who, to make life more complicated, are NOT required to switch to ICD-10. In your ICD-10 planning and prep stages you should have already identified which of your payers will still be using ICD-9 codes. If not, do it today.

Hopefully you’ve also checked with your software vendor to make sure your claims submitter will retain its ICD-9 functionality so you may accommodate the few payers who are not making the switch.

Primary and secondary payer headaches

You may find some of your patients have a non-HIPAA-covered payer (worker’s compensation) as their primary payer but a commercial insurance provider like Blue Cross Blue Shield as a secondary payer. So essentially you will have to first submit using ICD-9 codes, and then submit to secondary payers using ICD-10 codes.

To make life easier you should document these patients with both ICD-9 and ICD-10 from the beginning. By entering all of your patient’s insurance information into your billing system, it will prompt you to enter both code sets at the beginning of treatment enabling a smooth transition to a patient’s secondary insurance once his primary benefits have been exhausted.

Now, if you’ve gotten married you know there are some pretty important things that need to happen the day before your big day as well, like getting those hair extensions and remembering you agreed to write your own vows and panic. With ICD-10 there are some key things you should do on September 30th as well:

Identify all active cases that span the transition

If you haven’t started before today, you’ll really need to go through your case load and identify the ones that will span the transition period so they can be accurately coded with the old ICD-9 codes as well as the new ICD-10 codes.

Finalize your notes

Before the clock strikes midnight and October 1st officially arrives, you will need to finalize all of your notes for dates of service for claims that happen on or before September 30th. If you try and finalize notes after the transition has happened, things could get a little messy, so save yourself some hassle and follow this Crunch time guide to ICD-10 in addition to getting your notes in order before the big day.

To many, this ICD-10 transition feels a bit like a shotgun wedding because no one really has a choice whether they say “I do” to the new code set. While that may be true, the other truth is, it’s about time this country caught up to the rest of the world; postponing the big day any longer will only make things worse. If you have prepared yourself and your staff for the switch, things should go much smoother than you may be anticipating and no one will be left at the altar.

Care certification requirements, CureMD, HIPAA, ICD-10, physician authorizations


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