More Facts About ICD-10

1. Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015 - Unless your practice is able to submit ICD-10 claims, your claims will not be accepted by NCTracks or any other health insurance payer, public or private.  Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
2. Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes - Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
3. Costs could be substantially lower than projected earlier - Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
4. It’s time to transition to ICD-10 - ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:

• Improve coordination of a patient’s care across providers over time
• Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
• Support innovative payment models that drive quality of care
• Enhance fraud detection efforts

The secret to success will be to learn and understand what is changing so that your practice will be ready come October 1.