How do we Know Which Codes a Payer will Allow?

by  ChiroCode™
Feb 8th, 2016 - Reviewed/Updated Apr 26th

Question:

How do we know which codes a payer will allow?

Answer:

Many of the ICD-10 codes translate very closely or even identically, in some cases, from ICD-9 to ICD-10. It is likely that these direct or very similar crossovers in ICD-10 will process in the same manner as they have previously with ICD-9. That said, there are of course many new codes, combination codes and much more specific codes than what was available in ICD-9.

Providers should continue to use those diagnosis that are within their scope to diagnose and that most closely support patient documentation. More specific information as to which codes are best to use in certain circumstances will likely be defined by individual payers in the weeks and months to come. CMS, the ACA and other governing entities will also help to clarify certain ICD-10 issues that arise.

As always, billing personnel must carefully watch claims, review EOBs and be proactive in following up with any uncertainties to best familiarize themselves with payer expectations for ICD-10 billing.