ICD-10 Compliant

June 30, 2012 by  Filed under: Management 

Becoming compliant with ICD-10 as of October, 2014, (for now) means transition, and a lot of it. It’s a huge change for practices. The existing ICD-9 numerical codes are being replaced with ICD-10 CM (clinical modification) and ICD-10 PCS (inpatient procedure) codes. It will result in five times as many alphanumeric codes. In fact, ICD-10 consists of more than 68,000 codes (compared with approximately 13,000 ICD-9 CM codes). In addition, the new codes are longer and more specific.

The consequences of not being ready might be grim. Minimally they will include denials of payment, claims rejections and obstacles when coordinating care with other healthcare professionals.


There is much more that can go wrong. For example, workers compensation claims will still have be coded with ICD-9 codes. This means that upgraded system will have to be able to accommodate those codes also. If they can’t be handled in an automated fashion, the billers will have to manually reverse-map codes to properly code the workers comp.

Before any of that even happens, all of the practice management, EHR and other systems need to be at the 5010 standard. This time consuming chore means upgrading several different software programs with multiple interfaces to be able to recognize the new codes.


Now is the time to get close to your vendor because their performance will make or break your readiness. The relationship can be based on the answer to this question: What will you have upgraded and when will that occur?

Even before that, check with the vendor about their hardware storage. Specifically, do they have enough storage to warehouse the new codes? If not, ask about their timeline for obtaining it.

If you need a new vendor or have to add vendors, do it early. Credible vendors will be very busy later and may not be able to handle new clients. It’s crucial that your relationship is solid and honest on both sides.


Who is in charge of the transition? In a survey done by Vitera Healthcare 53% of the respondents said the practice manager is responsible; 23% named the billing manager as the project leader.

Whoever it is, make sure there is a clear line of responsibility. Prepare an organized, thoughtful training program for the staff. The billers and coders will obviously need to know the intricacies of the old and the new system codes.

The good news is that there are plenty of resources (seminars and workshops) available for learning the ICD-10 codes.

McLaughlin founded RMK ( http://www.rmk123.com ) in 1980. With two employees and a few small accounts, he developed the business that has collected and processed more than $100 million in debt collections since its inception.

The business focuses on medical billing, revenue management, accounts receivable management, collections, subrogation, revenue enhancement reviews, and billing office-staffing analysis in addition to its full collection agency service programs. RMK clients include major hospitals, medical clinics and providers from all over the US.

Contact Ronald McLaughlin for more information about RMK’s medical billing, coding and revenue management services.

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