Dual Coding & ICD-10 Transition

ICD-10 implementation is looming, and the industry is scrambling to prepare for the transition. Our post in May gives a broad overview of ICD-10 and how to prepare, but let’s talk now more specifically about “Dual Coding.”

ICD-10 Chalk


What is “Dual Coding?”

Dual Coding is the term that describes claims that have both ICD-9 and ICD-10 diagnosis codes. When a major change occurs, there is usually some leeway in the first few months that would allow for this type of claim to squeak through. This gives time for all players to get acclimated to the new requirements and how to implement them. Dual Coding has been a hot topic of sorts in our industry, with many wondering if it would be allowed.  With this release from Medicare, that question has been largely answered with a resounding “NO.” All claims after October 1, 2014 will be denied if they contain ICD-9 diagnosis codes. Private insurers are sure to follow suit.

What Can You Do?

Prepare! Medicare shows no indication of delaying the transition, and is pushing for quick and relatively painless transition. Rather than allowing for acclimation in the first few months, your practice will need to be prepared PRIOR to the transition date. October 1, 2014 may seem like a long way off, but this transition will require a complete overhaul of many office processes. Do not let your practice’s cash flow be affected by needless denials!

ICD-10 Transition – Coming Up!

The United States is one of the last developed countries that still uses ICD-9 for diagnosis coding. ICD-10 has actually been around since 1994, and has been used in Australia, Canada, and many countries in Europe since the early 2000s.  Advances in diagnostic technology allows for more specificity, and ICD-10 offers a way to report to that level. Some main differences are:

  • Available codes jump from 13,000 with ICD-9 to 68,000 with ICD-10.
  • ICD-9 codes are mainly numeric (unless a “V” or an “E” code) and are 3-5 characters in length. ICD-10 are alpha-numberic, and 3-7 characters.
  • The additional characters in ICD-10 format specify the etiology, the anatomic site, and severity.

When new healthcare regulations and are set to roll out, the industry knows the deadline will likely be pushed back (sometimes multiple times). It is looking more certain that ICD-10 transition will be the exception to that rule, and October 1, 2014 will be the implementation date.

Will You Be Ready?

CMS has released suggested timelines , but each practice should really tailor their transition plan to fit their needs. Healthcare claims billing and reimbursement is a true collaboration between many players.  Here are a few of those players and how things may change due to ICD-10:

  • Clearinghouse and Software: Software programs will need to be updated to recognize and accept the new codesets, and your clearinghouse will also need to update their edits. Your clearinghouse should also be keeping you updated on payer readiness as it gets closer to implementation. In Charge Office Solutions takes care of this for their clients.
  • Office Staff: All office documentation that currently uses ICD-9 codes will need to be updated to accommodate for the new codeset. This may include superbills, lab orders,etc.
  • Healthcare Providers: Because each diagnosis must be coded to the highest level of specificity, Providers will need to become familiar with the level expected and document their encounters accordingly.
    EX:  Open wound of left cheek:
    ICD-9 “873.51” which specifies open wound of cheek, complicated.
    ICD-10  “S01.402A” specifies the first encounter for an open wound of left cheek and temporomandibular area.

In Charge Office Solutions will be working with each client to help ease the transition for their practice, and make it as seamless as possible. Rather than a burden, ICD-10 is a means to advance the accuracy of claims reporting and documentation.

Sign up for our newsletter (found on our homepage) for news of ICD-10 changes.