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Archive for ICD-10 Codes

ICD-10 Codes: ICD-10 Changes – Filing Your New Claims

ICD-10-CM is the diagnosis code set that replaced ICD-9-CM Volumes 1 and 2. ICD-10 is used to report diagnoses in all clinical settings. All providers, including physicians, health care clearinghouses, and payers must comply with ICD-10 to meet the Health Insurance Portability and Accountability Act (HIPAA) requirements.

ICD-10 codes went into effect on 10/1/15 for claims with a date of service on or after 10/1/15 and replaced an outdated code set that had been in effect for over 30 years. This update was essential to reflect advances in medicine, medical technology and knowledge. The greater detail available in the ICD-10 code set means that the code can provide more specific information about the patient diagnosis.

 

While many payers struggled to prepare for ICD-10, APEX EDI successfully tested ICD-10 claims with Medicare, Blue Cross Blue Shield, Medicaid, Worker’s Comp, and other payers. We also participated in numerous ICD-10 webinars and training sessions with providers and industry leaders in billing and paying services.

Apex EDI recognizes the change to ICD-10 as a significant shift for healthcare providers. Many providers have experienced disruptions in transactions being processed and receipt of payments. Physicians have been urged to set up a line of credit to mitigate any interruptions in cash flow.

Our systems were updated early in this change to transmit ICD-10 codes. Contact us today because we have a supportive, friendly staff available to simplify all phases of this change for you. We will answer questions, offer educational resources, test your claim files, and work with channel partners and payers to ensure you receive faster payment in compliance with current codes and regulations.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

 

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ICD-10 Codes: Free Fact Sheets – Common ICD-9-CM Codes and Possible ICD-10-CM Equivalents

ICD-10 Codes: Free Fact Sheets – Common ICD-9-CM Codes and Possible ICD-10-CM Equivalents

The ICD-10 deadline is here and Apex EDI realizes that you may need additional resources to help make the transition smooth. We have compiled three fact sheets identifying commonly used ICD-9-CM codes and matching them with their possible ICD-10-CM equivalents, one sheet for General Medicine codes, one for Ophthalmology codes, and one for Chiropractic codes.

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Please note this tool is not designed to provide perfect matches between the two coding systems. In fact, except for a minority of cases, perfect matches between the ICD-9-CM and ICD-10-CM coding systems do not exist. Given the significant increase in detail and specificity in the ICD-10-CM coding system, in most cases there is no direct match between ICD-9 and ICD-10 codes. A clinical analysis is required to determine which code or codes should be used. It is important to remember that even when there is only one ICD-10 code, it is not necessarily completely equivalent to the source ICD-9 code. This tool is not designed to replace proper training and documentation.

Proper coding begins with the doctor and documentation. While Medicare Part B is not going to deny claims based solely on the specificity of the ICD-10 diagnosis code as long as the codes are from the right family, they may pay less than what they have paid in the past based on the specificity of the diagnosis code. These tools are meant to shorten the amount of time spent looking up codes for best specificity. Most of the conversions identify the family where the appropriate crosswalk can be found. In the rare occasions where there is a direct crosswalk a clinical analysis is still required to determine if the crosswalk is appropriate for the billing situation.

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