What health claims specialists need to know about imminent changes in medical billing and coding
If you’re in a health claims specialist training program, or if you’re thinking about enrolling in a program to become a medical billing and coding professional, you’ve probably heard a lot of talk about the upcoming switch to ICD-10.
Whether you already have a sense of what that means, or whether it all just sounds like alphabet soup to you, we’re here to explain why the change is happening and how it affects people working in the medical billing and coding field.
What does ICD mean?
ICD stands for the International Classification of Diseases, which is the World Health Organization’s (WHO) system for standardizing codes for various medical diagnoses, procedures, and causes of death.
ICD-9, the system currently in use in the United States, is based on the 9th revision of the ICD. The WHO recently completed the 10th revision of the ICD, referred to as ICD-10.
Why is ICD-9 being phased out?
ICD-9 was created in 1979. Since then, it has become outdated due to advances and changes in medicine.
What’s different about ICD-10?
ICD-10 is much more expansive than ICD-9. ICD-9 codes are three to five digits and encompass 14,000 unique diagnosis codes and 4,000 unique procedure codes. ICD-10 codes will be three to seven digits, creating more than 69,000 diagnosis codes and 72,000 procedure codes.
This massive surge of new codes is meant to allow for the capture of data regarding signs, symptoms, risk factors, and comorbidities (that is, when a patient has two or more conditions at the same time), in addition to procedures and diagnoses.
Changing over to ICD-10 means that the United States can more easily exchange information with health providers in other countries, and information with WHO to track global health information.
Are all medical practices affected by this change?
All medical providers bound by the Health Insurance Portability and Accountability Act (HIPAA) must change over to ICD-10.
Practices that are not bound by HIPAA are not required to make the switch, although they may find that their codes are outdated if they continue to use ICD-9.
How does ICD-10 affect medical billing and coding professionals?
Any procedures billed on or after October 1, 2015, must conform to ICD-10 codes or they will be considered non-compliant with HIPAA.
Beyond that, claims that aren’t submitted using ICD-10 codes will be rejected by the Center for Medicare and Medicaid Services (CMS) and other payers. Claims that need to be re-submitted may result in a lag time for payment, which could have an impact on a practice’s bottom line.
All of these changes mean that skilled and diligent medical billing and coding professionals will be in demand. The U.S. Bureau of Labor Statistics reports that this field is expected to grow by 22%, which is must faster than average compared to other fields.
For more information on the switch to ICD-10, check out CMS’s Road to 10 site. Of course, students in Salter’s health claims specialist training program can talk to their instructors about any questions they may have.
Interested in learning more about a career as a medical billing and coding professional? Request more information or schedule a tour at one of Salter’s campuses in eastern Massachusetts.