ICD-10 goes into effect October 1, 2013.  This is the biggest change in medical billing in years.  ICD-10 has fundamental changes in structure and concepts that make them very different from ICD-9. 

The shear change in the volume of codes will be daunting.  ICD-9 has 13,000 diagnosis codes and 4,000 procedure codes totaling 17,000 codes, while ICD -10 has 68,105 diagnosis codes and 72,589 procedure codes totaling 140,694 codes.  The ICD -10 codes will also have more digits and will be in different formats.

For example, if a patient is seen for treatment of a burn on the right arm, the ICD-9 diagnosis code does not distinguish that the burn is on the right arm. If the patient is seen a few weeks later for another burn on the left arm, the same ICD-9 diagnosis code would be reported. Additional documentation would likely be required for a claim for the treatment to explain that the burn treated at this time is a different burn from the one that was treated previously. In the ICD-10 diagnosis code set, characters in the code identify right versus left, initial encounter versus subsequent encounter, and other clinical information. 

The ICD-10 code sets are not simply increased and renumbered ICD-9 code sets. The move to ICD-10 will not be easy. The ICD-10 code sets include greater detail, changes in terminology, and expanded concepts for injuries, laterality, and other related factors. The complexity of ICD-10 provides many benefits because of the increased level of detail conveyed in the codes. The complexity also underscores the need to be adequately trained on ICD-10.

Today’s billing takes a highly specialized skill set to be successful and compliant.  Medical billing is an ever changing complex field of codes, modifiers, rules and regulations.  Billing has become a specialty unto itself.  Outsourcing billing has become popular because it’s less expensive and more efficient than in-house billing. 

Finally, every practice needs to decide whether or not they want the additional burden of running a billing operation.  To do it half way will cost every practice a fortune in lost revenue.  Even the AMA has stated a typical in-house biller will leave 10% - 15% of revenue uncollected.  I was always taught never do something that others can do better, faster and cheaper than yourself.  Focus on helping patients and outsource the billing.

Barry Shatzman is a Certified Healthcare Billing & Management Executive (CHBME), and Chief Operating Officer of Medical Billing Resources, Inc., in Farmington Hills, Michigan.  Please feel free to comment on this post or to contact him directly at barry@medicalbillingresources-mi.com, or at 248-932-2607.

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