Medical Billers Articles

Geez, As If Processing A Health Insurance Claim Wasn’t Already Tricky Enough – Here Comes ICD-10

By Jeffrey L. Greyber, Esq.

So, come October 2015, medical professionals (and agents who process the bills of medical professionals) in the United States will be required to use ICD-10. “ICD,” by the way, is short for International Statistical Classification of Diseases and Related Health Problems. In a very small nutshell, the ICD schema is the method by which clinical information (such as diagnoses) is charted and insurance claims are processed.

Last I checked, ICD-10 consists of over 14,000 codes, the ICD-10-CM (clinical modification) consists of over 60,000 codes, and the ICD-10-PCS (procedural coding system) consists of over 70,000 codes. By my calculation, that roughly quintuples the amount of codes available under ICD-9 (which such schema is over thirty years old). That massive jump in available codes (along with the fact that it took over ten years for ICD-10 to even be created) should tell you how much more complicated (or intricate, depending on how you look at it) charting and claim processing will become.

Do not get me wrong, in the long run I believe ICD-10 will be a good thing. Again, ICD-9 is over thirty years old, and think about how much healthcare has evolved over that amount of time. Among other things, more codes mean that medical professionals will be able to more accurately document clinical information. This, in turn, will doubtless result in better patient care. But, despite the long-term benefits of ICD-10, again, there will be a steep learning curve in the short-term for the folks who have to implement ICD-10.

It is that complicated learning curve that we would like to help you with. If you are having troubles getting claims paid under the new ICD-10 schema, please do not hesitate to contact us and we will analyze what the disconnect with the insurance company is and how it can be solved. As always, our initial analysis is free. We look forward to working with you.

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