GAO: CMS ready for ICD-10, but are you?

There is good news for healthcare providers coming out of the Government Accountability Office: The Centers for Medicare and Medicaid Services is prepared for the switch to ICD-10 on Oct. 1, according to a newly released report.

The 41-page report notes that CMS has undertaken “a number of efforts†to prepare for transition to the tenth revision of the International Classification of Diseases, better known as ICD-10. These codes are used for documenting patient medical diagnoses and inpatient medical procedures. They are used to determine whether the care provided is medically necessary and eligible for reimbursement.

Among those efforts CMS has:

• Developed checklists and timelines that providers, clearinghouses and health plans must meet.
• Conducted outreach, including in-person training for small physician practices in some states.
• Monitored covered entity and vendor readiness through meetings, focus group testing and review of surveys conducted by the healthcare industry.
• Modifying its Medicare systems and policies.
• Providing technical assistance to Medicaid agencies and monitored their readiness.
• Taken steps to address areas of concern from stakeholder organizations.

The transition to ICD-10 initially was to have taken effect on Oct. 1, 2013, but that deadline was pushed back twice. The GAO report noted that some stakeholders representing covered entities have said the delays have been costly and burdensome to those prepared for the initial transition, while others had voiced concern that they would not have been ready and were happy they had been afforded more time.

ICD-10 dramatically increases the number of diagnostic and procedure codes. Under ICD-9 there are about 15,000 diagnostic codes and about 4,000 procedure codes. Under ICD-10, that number increases to about 70,000 diagnosis codes and 72,000 procedure codes. The additional codes are designed to allow providers and payers to provide greater specificity and clinical information in medical claims.

With ICD-10 fast approaching and without another extension in sight, The Health Law Offices of Anthony C. Vitale can assist your practice in navigating the minefields of this highly complex set of coding principles.