ICD-10: What You Need to Know

Take an eye to the new ICD-10 mandates and learn what benefits they bring to chiropractic, what major challenges they will present to your practice, and new changes to the deadline.

It's no secret that the ICD-10 transition has been looming on the health care horizon for quite some time now. But despite overwhelming opposition and a firm stance by CMS, the deadline has been extended yet again. On March 31, the Senate passed the Protecting Access to Medicare Act of 2014 by a vote of 64 to 35, effectively delaying the ICD-10 deadline by another year. This delay was coupled with the so-called "doc fix", or a delay to the sustainable solution proposal for the rate that CMS pays physicians for treating Medicare patients. This permanent fix to the sustainable growth rate formula used to fund Medicare would have resulted in a 24% cut in Medicare payments, starting Tuesday.

Although a delay in the pay cuts may come as a relief to providers, the longer Congress puts off fixing Medicare's SGR formula, the bigger the elephant in the room will become. The hope is that with an extension of this deadline, a successful alternative solution can be found that will be less costly to physicians.

But without a proper plan to implement ICD-10, next year's deadline could offer up the same coding challenges to unprepared providers as it did this year. Therefore, the onus is on each chiropractor to take this time to prepare, and ensure that when October 2015 hits, they are ready for the challenge.
When ICD-10 does come into play, there will be no overlap wherein both types of codes will be accepted. This hard-stop on ICD-9 codes means that close attention must be paid when billing near the 2015 deadline. But keep in mind, this does not mean that providers can transition early to ICD-10. CMS and other payers will not be processing the new claim format until the compliance date.

Although the transition to ICD-10 will remain challenging, let's also take a look at some of the benefits that ICD-10 will inevitably bring to the chiropractic community:

  • The word subluxation will be introduced into code descriptions. The sixth character of a code now differentiates between subluxation and dislocation. 0=subluxation 1=dislocation.
  • Better defined codes means less reliance by payers on supporting documentation for approval. An addition of right and left codes tells the complete story without the need for additional documentation, allowing insurance companies to place less reliance on providers' notes.
  • Better coding means better tracking and a better understanding of the benefits of chiropractic courses of care.
  • ICD-10 codes can be expanded upon, allowing for future flexibility.
  • More accurate codes means more accurate reimbursement by payers.

In preparation for this transition, it's crucially important to make the investment in training your staff early. Money spent on training and education is an investment both productivity and accuracy that adds up to fewer rejections, less time spent reworking claims, and an uninterrupted cash flow for your practice. The ICD-10 code set is increasing in number from 13,000 to 68,000. Some of these codes map easily in a 1-1 conversion, others are a 1-3 conversion or more. This means you and your staff must be educated on common codes so they are prepared to make these custom assessments on-the-fly.

To put our providers in position for this adjustment, ChiroTouch stands ready to deliver both the technology and training for our family of practices. Contact ChiroTouch to learn more about how we can keep your practice running with a comprehensive approach to billing, compliance, and industry standards.