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How do I know which ICD-10 codes payers are going to like?

Published:  November 26th, 2013

One of the biggest questions doctors have is “Which codes will I actually use when ICD-10 kicks in on October 1, 2014?” This is the great mystery. Fortunately we have access to the same code set that payers will be using as they determine which codes they like to see. We may not know exactly which codes are going to work, but we can, and should, get familiar with the options now, so that we are comfortable with whatever the payers pick. 

We turn to Medicare for guidance on this because we know that many payers also look to Medicare as an example to follow. Each Medicare Administrative Contractor (MAC) releases a “Local Coverage Determination” (or LCD) for each specialty. Your MAC will have an LCD available for Chiropractic physicians in your area. The easiest way to find yours is to use the Medicare Coverage Database: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx#HowToUseThisSite Simply select your state and type in “Chiropractic”. The LCD for Utah (where ChiroCode is based) is only 11 pages long. It might be wise for every office to take a little time out and read it over. It lists, among other things, acceptable ICD-9 codes for Medicare claims.

LCDs are likely going to be the first place to look for acceptable ICD-10 codes. There were rumors that the LCD with ICD-10 codes would be available in October of 2013. But, October has come and gone. According to MLN Matters, document #MM8348 (see http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf) all LCDs with ICD-10 codes must be available in the Medicare Coverage Database by April 10, 2014. CMS knows that providers need time to make changes and updates to their billing and documentation systems. If your MAC waits until the last minute, you will still have six months with the updated list.  Check back with ChiroCode for the latest. We will send out updates as soon as we hear.

In the meantime, keep in mind that ChiroCode’s Complete and Easy ICD-10 Coding for Chiropractic book (see https://chirocode.com/2017-icd-10-cm-coding-chiropractic) contains all of the codes that payers are most likely to choose.  The book can help you start your transition now. If you decided to plan to a trip to Greece on October 1st, and you wanted to learn to speak Greek before you go, you would not wait until September 25, 2014 to start studying. It would be far easier to learn if you studied for ten months, a little every week. ICD-10 is really a new language and doctors and billers will need to invest some study time in order to become fluent. ChiroCode’s book will help you to lay out a clear plan to get you ready for this major change. It is advised that you start now.

Payers have indicated that they will not be able to accept ICD-10 codes prior to October 1st, but test claims will create an opportunity to see how everybody will handle these new codes. One Blue Cross Blue Shield plan sent out a letter to providers many months ago, indicating that they will be able to accept test claims in early 2014. Medicare recently announced that they will have a testing period open from March 3 to March 7 of 2014 (see http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8465.pdf). Watch for more information about how you might be able to participate. In the meantime, get started now and you will be a lot less stressed when the deadline hits.

 

 

 

 

 

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