Three Questions ENTs Should Be Asking About ICD-10

Obaid Rahman / January 18, 2016

The medical industry is constantly growing and changing every day. With all kinds of new advancements that affect different medical professionals worldwide, it’s best to become educated in these advancements sooner rather than later. Among these advancements, there is a new implementation soon to be taking affect known as ICD-10. What is this new code set and how does it directly affect you as an ENT? Some of the basic questions that should be asked about this new mandated system will be covered in this article.

Download ICD-10 Myths and Facts Guide Here

First off, what exactly is ICD-10? According to the World Health Organization (WHO), it is a medical classification list. The International Statistical Classification of Diseases and Related Health Problems (ICD), mandated by the WHO has reached its 10th revision, thus identified as ICD-10. This is the next generation mandated code set for diagnosis and inpatient procedure coding billed to support the medical industry worldwide for the next two to three decades. As the healthcare industry in the United States implements a broader use of healthcare IT, many different healthcare providers will be searching for ways to upgrade or purchase administrative and clinical IT systems.

The new codes will change many parts of healthcare processes, which will include such things as billing and payments to patient referrals as well so this should be a legitimate concern when looking for health IT. So, what are some things to keep in mind about this new code set, and what questions should you, as an ENT, be sure to ask?

1 When will this new code set take affect and why?

According to the Centers for Medicare and Medicaid Services (CMS), these new codes must be used to identify transactions of all diagnoses such as pre-authorizations and claims, for all services completed on or after October 1, 2015. The reason for these needed changes is simple. ICD-9 is outdated and unfortunately running out of space for the new code set. A majority of the terminology being used in the older code set no longer accurately covers all new discoveries of diseases and necessary treatments. With the lack of specificity in the older code set, bio-surveillance is not being supported, and public health tracking as well as research is no longer well supported, which is extremely important.

2 Who has to use this new code set and what are the biggest changes?

According to the Centers for Medicare and Medicaid Services (CMS), these new codes must be used to identify transactions of all diagnoses such as pre-authorizations and claims, for all services completed on or after October 1, 2015. The reason for these needed changes is simple. ICD-9 is outdated and unfortunately running out of space for the new code set. A majority of the terminology being used in the older code set no longer accurately covers all new discoveries of diseases and necessary treatments. With the lack of specificity in the older code set, bio-surveillance is not being supported, and public health tracking as well as research is no longer well supported, which is extremely important.

3 Where can my practice find the new ICD-10 Codes and will they all have to be learned?

The official guidelines for the ICD-10-CM, ICD-10-PCS code sets are available for free on the CMS website. In addition, the website also has a wealth of supporting information for those transitioning from ICD-9 to ICD-10. The new code set is well-organized and provides a simple way of locating codes that are relevant to your specific practice. Learning all the codes is not required or necessary, however, it’s important to identify and learn the codes related to your practice and become familiar with them as soon as possible.

It is recommended to begin training your staff on the new code set as soon as possible. Training and testing will potentially take up to 9 to 12 months, so beginning this transition early is essential to kick off implementation in time. This new code set will affect every area of your ENT practice so it should be at the forefront of things to be addressed.

Download ICD-10 Myths and Facts Guide

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