New ICD-10 Coding Changes Coming 10/1/2016

We have almost one successful year of the transition from ICD-9 to ICD-10 behind us! There are some new updates and changes that will take effect, again, on October 1^st, 2016. While these changes are not as extensive as the transition that took place in 2015, there are some notable items you will want to review.  Some of the codes you use day to day have been updated and may require additional characters. Please take some time to visit with your software vendor on how they are handling these changes for October 1^st, 2016, and make sure you have the latest updates installed prior to the deadline! 

Flexibility period for claim filing is ending

In addition to this update, that is effective on October 1st, Medicare is removing the ‘flexibility’ period of not requiring the highest level of specific coding. Now is a great time to get in the habit of avoiding unspecified codes and making sure you are drilling down to the most specific code or codes possible when seeing and treating your patients.  Review the items and links below to get informed and make any adjustments needed for your practice prior to new changes on October 1^st, 2016.

Helpful tools and resources

□   ICD10data.com’s website has a summary of new, revised, and deleted codes. Remember that codes with a green arrow next to them are good, billable codes. Codes that have a red arrow next to them are not valid, and should not be used to bill services.

http://www.icd10data.com/

□   You can also find helpful downloads and reference material on the CMS website. There are many files here to review and you can download the content that will best support your practice.

o   The ICD-10-CM_ConversionTable-FY17 is pretty helpful. It will show the new, or current code assignment, the date it is effective, and the previous code assignment

2017 ICD-10-CM and GEMs (General Equivalence Mappings)

• Example image of the downloaded spreadsheet below:
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https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html

□   Medicare’s most recent information on the expiration of ‘flexibility’ in processing diagnosis codes starts on page 9 with question number 28 and continues through question number 33 on page 11.

o   You can access this document by clicking the link below the image.

• Example image of the Q& A sheet below:
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This may not reflect any changes after publication on the OBS website

https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf

For those of us who live in the world of health insurance, we sometimes forget how confusing it can be for our patients.  We recently had a doctor who was concerned because so many of her patients didn’t understand their deductibles, copay, coinsurance, etc., and their confusion resulted in frustration that was often directed at her staff.

If your staff has to deal with patients who are frustrated because they don’t understand why their insurance didn’t pay more, perhaps the handout we’ve prepared will help!  It’s purpose is to explain common insurance terms that deal with patient responsibility for their healthcare costs.  In addition, it’s meant to remind patients that their coverage is based on decisions they made when choosing a healthcare plan, and that as their healthcare provider you have little control over what their plan covers.  This is a conversation patients must have with their insurance company.

Let us know if your staff finds this handout helpful!  We are always looking for ways to make your staff’s jobs easier.

Link to Patient Insurance Education handout:  Helping Patients Understand their Insurance