ICD-10 Has Arrived

After years of planning and delays, ICD-10 finally arrived.  Many agencies are slowly adapting to the new coding and requirements.  The early few weeks has brought on some confusion, but that was expected.  We also saw that the transition amongst some software providers also caused a few glitches, but were easily taken care of.


Since ICD-10 is here for the foreseeable future, it is time to step back and think about how this has changed your operating model.  Coders and the Quality Assurance staff will be taking a month longer, deeper review of codes chosen. Verification of those codes and discussion amongst staff will also be a good way to ensure that coding doesn’t impact reimbursement.


Communication between your agency and the payers – whether it be Medicare, Medicaid or private insurance is going to be essential.  Each Medicare intermediary sends out status updates on claim processing. If you aren’t subscribed to these updates, we recommend you go to your intermediary’s website and join their email alerts.    Private insurers have actually been one of the biggest helps to providers and their sites contain a large amount of resources and information.


A few other reminders that should become a best practice for your agency:

  • Review your Dates of Service (DOS): Medicare episodes that started before October 1st, will still need to be coded using ICD-9, even if the episode ends or the patient is discharged after the October 1st


For some per-visit based claims, such as private insurance or Medicaid claims, you might have to split bill for dates of service that cross over the months of September and October.  September visits would be billed on one claim with ICD9 coding, while October visits would be billed on a separate claim with ICD10 coding.  This will have a big impact on agencies that bill weekly or bi-weekly since October begins on a Thursday.  Essentially, the billers will be generating twice the bills for a single week.


This can also cause difficulties when reviewing back billing or submitting late billing.  Remind staff to check the coding and the insurance carriere’s specific requirements to avoid denials due to coding confusion.


  • Allow Staff to Work Overtime: Since the additional time required for ICD-10 has a direct impact on your cash flow, allowing QA staff to work additional hours and be compensated through overtime pay or paid time off (PTO), will only help your agency.  The important concept to focus on during this conversion period is that ICD-10 takes longer and therefore submission of claims is delayed which reduces and tightens your cash flow.  For many agencies, whether large or small, this is not a good option.


  • Crosswalks, ICD-9 to ICD-10: Depending on the population of your agency, this might be easier for some patients than others.  However, you must carefully review the new ICD-10 code to make sure it accurately fits the patient diagnosis.  There are several excellent resources available to help your agency’s coding and QA staff determine the correct ICD-10 codes.  We have included them at the end of this article.  Your OASIS software may also offer some helpful tools for coding to maximize accuracy and reimbursement.


  • Separate Denials based on DOS: As you have begun to submit claims, some rejections or denials will likely occur.  Carefully examine these claims and the reasons why.  If the denial is not due to coding, you can quickly correct the claim and resubmit.  However, for claims that are denied or rejected due to coding errors, you must determine exactly why.  In some cases you may need to speak to your software company’s help desk, while in other cases, you may need to speak with a knowledgeable account representative with the specific insurance company.


The challenges of ICD-10 are still surrounding agencies like yours.  It will take some time and some adjustment in operations to get your agency fully converted into an ICD-10 way of thinking. We will be helping you guide the conversion process with information and tools throughout the next few months.  Please remember, we are also available as a resource in addition to those below!




ICD-10 Translator and Crosswalks:  www.aapc.com/icd-10/codes