AMA CPT® Assistant - 2015 Issue 11 (November)
Managing Potential ICD-10-Related Issues (November 2015)
November 2015 page 9 Managing Potential ICD-10-Related Issues With the International Classification of Diseases, Tenth Revision (ICD-10), both the Clinical Modification (ICD-10-CM) and Procedure Coding System (PCS), now in effect, all health care claims and other administrative transactions (eg, eligibility, prior authorization and others) for dates of service on and/or after October 1, 2015, must be coded with an ICD-10-CM diagnosis code. Transactions that are reported with ICD-9-CM diagnosis codes for services provided on and/or after October 1, 2015, will be rejected by all payers. As a result of the newness of the transition and the complexity of the...
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Article Overview
This article addresses practical, high-level concerns tied to the ICD-10 transition and the early implementation period. It explains the kinds of claim and transaction issues that may surface, why careful review of rejected or delayed claims matters, and the general places providers can turn for help, including Medicare, Medicaid, commercial payers, vendors, specialty societies, and other external resources. The article is aimed at practices and billing professionals who need to understand the scope of ICD-10-related operational issues without delving into detailed coding guidance.
Why This Topic Matters
The ICD-10 transition affected claims, authorizations, and other administrative transactions across payers, so even small processing issues could create payment delays or denials. Understanding the broad support channels and escalation paths helps practices respond efficiently and reduce administrative disruption.
Article Sections
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November 2015 page 9
Publication and issue information for the article.
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Managing Potential ICD-10-Related Issues
Overview of the ICD-10 implementation period and the types of administrative problems that may occur during the transition.
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Medicare
General guidance on where to direct Medicare-related ICD-10 concerns and how to locate CMS support resources.
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Medicaid and commercial payers
Broad advice on checking payer resources for information and contact options related to ICD-10 issues.
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Vendors
Direction for addressing system, clearinghouse, and billing-platform issues with the appropriate vendor or service provider.
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State and medical specialty societies
Mention of professional organizations as potential sources of advice and peer experiences related to ICD-10 challenges.
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Other resources
Reference to an external professional association resource for additional ICD-10-related information.
What You Will Learn
- How the article frames common ICD-10 implementation challenges
- Which broad categories of organizations may help resolve ICD-10-related claim issues
- What types of administrative transactions are affected by the transition
- How the article suggests approaching investigation of claim-processing problems
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle professionals
- Compliance staff
- Healthcare administrators
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