In Claim Management Best Practices

By October 1st, 2015, everyone who is covered by the Health Insurance Portability Accountability Act (HIPAA) is required to transition from ICD-9 to ICD-10 codes. The ICD-9 codes currently in use are outdated and no longer considered usable for today’s treatments, reporting, or payment processes.

The format of the ICD-9 code set makes it difficult to expand and reflect changes in medical terminology and knowledge. The ICD-10 code set reflects these changes, is more flexible for expansion and includes new technologies and diagnosis. The code set has the ability to include greater detail through additional codes and expanded code format in the future.

The differences between the ICD-9 and ICD-10 code sets are significant and require physicians and practice management to properly familiarize themselves with the differences before October 1st. All services and discharges must be coded using the ICD-10 codes starting by the 1st of October 2015, or they will be considered non-compliant. Any non-compliant transactions will not be processed, resulting in delayed transactions and payments.

The ClaimVantage claim management system integrates with Reed Groups MDGuidelines to allow employers, insurance carriers and third party administrators (TPA’s) to assign ICD codes to claimant information. ICD codes provide insurers with more detail on a particular diagnosis in an internationally used format. The upgrade to ICD-10 will provide even more insight into each diagnosis allowing insurers to have access to more detail, resulting in more detailed assessments, and hopefully quicker claim processing times.

For example, in the current ICD-9 code set, the code for polyneuropathy in diabetes is 357.2. The ICD-10 equivalent has four separate codes to give more information on the specific diagnosis:
• E0842 – Diabetes mellitus due to underlying condition with diabetic polyneuropathy.
• E0942 – Drug or chemical induced polyneuropathy in diabetes
• E1042 – Type 1 diabetes
• E1142 – Type 2 diabetes
• E1342 – Other specified

ClaimVantage will ensure all users can easily transfer over to the updated ICD-10 codes set by October 1st next year. To learn more contacts us today.

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