The International Classification of Diseases (ICD) is the medical diagnosis classification losing used to allow payers to understand the patient’s medical diagnosis so they can reimburse for services rendered and bill under the Current Procedures Terminology (CPT) codes.

From 1979 until last year (2017) all providers in the US used ICD-9. The next phase for the international diagnostic codes is ICD-10.  This new system utilizes the present technology to handle greater data capacities to diagnose illness and injuries in a far more specific manner.

The more specific data will help the World Health Organization to more quickly identify emerging health issues around the globe.  Do United States medical community is far behind in utilizing ICD 10. Most providers across the globe complied with being ICD-10 compatible by October 2014.

If you have not yet switch to ICD 10 you are probably not getting reimbursements properly. If you only partially switch to ICD 10 you really need to go full force and make sure your entire billing process is ICD 10 compliant. Here are the 4 steps we suggested our clients go through to make themselves ICD 10 ready.

Step 1: Identify & Implement – figure out how moving to ICD 10 is going to affect your operation specifically.

Step 2: Prepare – utilizing your present software vendor or finding a new software vendor and/or your clearinghouse make sure your software will all be compatible with the new codes.

Step 3: Live trial – once your software and clearinghouse are in place, and you have taken the time to look through your top list of ICD nine codes and the transfer codes into ICD 10 make sure your 5010 platform is perfect for file transfers.

Step 4: Tweak to perfection – recognize that no system will work properly and perfectly at first. Be prepared to identify and correct all issues which occur in Step 3.

At the present time most software companies and clearing houses are fully compatible with ICD 10. They have been preparing for many years and were provided a number of postponements to allow for the complete transition. Although the transition was not completely smooth hopefully your office is running without too many hiccups. If you are still having problems in your ICD 10 trans pronation it maybe your billing software and or billing company or not up to the task.

The two most important billing and coding organizations (AAPC & AHIMA) have been training and credentialing billing and coding professionals in ICD-10 for a number of years. They are able to help you find credible people to make your medical practice better.

Tips for the transition-

  1. Prepare a list of currently used ICD-9 codes from the most used code to the least used code.In that order find the corresponding ICD-10 code. To do this you can use an old-fashioned handbook or there are many ICD Translator’s or Cross coding tools on the market. Mapping ICD 10 to ICD nine codes is not easy due to the specificity and complexity of the new coding system. Software can’t help but training and experiential knowledge is the best method of learning ICD 10. You may want to hire an outside professional to come in and help with the process. Also remember that the AAPC and Medicare both have created an online tool for ICD-10 code translation.
  2. Once you identify your most common ICD-10 codes create a list of the “documented findings” the practitioner must establish in the exam to perfect the claim. Then meet with your practitioner and educate them on the new specific diagnostic findings needed for proper billing. Practitioners are often so caught up in the practice of medicine that they fail to fully understand the nuances and details needed for the business side of medicine. Educating them on the new ICD-10 coding needs will greatly reduce your stress and the number of claims denied. It will also increase money coming in the door. In our experience using predetermined “super bills“ will also help the Practitioner to complete the diagnostic codes properly.
  3. Throughout this process make sure that you are working with and in conjunction with any software vendor which you use. Almost all vendors are fully fluent in ICD-10 codes at this point. If they are not, find new software!




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