ICD-10, Dual Coding, and Dual Processing
Discussions of ICD-9 and ICD-10 often include mention of the terms dual processing and dual coding. Different people use these terms to mean different things, but in general, dual coding or processing refers to the use of ICD-9 and ICD-10 codes at the same time. So, when can you expect to use dual coding and processing and when can’t you?nnTesting to Prepare for ICD-10nDual coding and dual processing can be useful tools to prepare for ICD-10 by testing whether you are able to prepare, send, receive, and process transactions with ICD-10. However, ICD-10 can be used for testing purposes only before the compliance date; providers and payers cannot use ICD-10 in “live” transactions for dates of service before the ICD-10 compliance date.nnDual Coding and Dual Processing After the Compliance DatenFollowing the ICD-10 compliance date, providers and payers must use:n
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- ICD-9 in transactions for services provided before the compliance date
- ICD-10 in transactions for services provided on or after the compliance date
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nWhile providers and payers must be able to use both ICD-9 and ICD-10 codes after the compliance date to accommodate backlogs in claims and other transactions, they will not be able to choose to use either ICD-9 or ICD-10 for a given transaction. The date of service determines whether ICD-9 or ICD-10 is to be used.nnWhen Is the ICD-10 Compliance Date?nThe Department of Health & Human Services (HHS) has released a final rule that included a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The new compliance date gives providers an extra year to prepare. The final rule also requires the continued use of ICD-9 for services provided through September 30, 2015.
C43.31 – Malignant melanoma of nosennC43.11 – Malignant melanoma of right eyelid, including canthusnnD03.4 – Melanoma in situ of scalp and necknnD03.59 – Melanoma in situ of other part of trunknnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
Z02.0 — Encounter for examination for admission to educational institutionnnZ55.3 — Underachievement in schoolnnY92.157 — Garden or yard of reform school as the place of occurrence of the external causennY99.8 — Student activity as the external cause statusnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
Legislation passed this year (House Bill 14-1283, now CRS 12-42.5-403) requires all Colorado prescribers who possess a DEA registration and all Colorado licensed pharmacists to register an account with Colorado’s Prescription Drug Monitoring Program (PDMP). Prescribers with a DEA registration and pharmacists must register an account by the corresponding deadlines below:n
The fee-for-service world of professional reimbursement (compensation for services) is, essentially, the following economic transaction between payer and provider:n
There is a tipping point however! Payers, who have fully insured customers, partially funded and self-funded customers (Employers and increasingly Affordable Care Act/Exchange membership) simply pass along the cost of care, one way or another, to their customers. Those customers (i.e. employers) have for far too long simply absorbed the increasing costs (or they have passed it along to their employees in the form of higher premiums, higher and higher cost share, deductibles, co-payments, etc.) and now we are seeing a rebellion. Why?…because they now can!nnThe payers and the traditional way their “product” (health insurance coverage) and “services” (paying claims, developing a network, medical management, etc.) are sold is going through just as much change as is being felt on the provider side. The brokers and direct sales people are having their commissions cut, employers are revolting – threatening to just allow their employees to go at it alone through the ACA and all of this is combining with the latest generation of work force who no longer stay with an single employer for very long and thus do not value the very expensive benefits lavished upon them. The young and healthy (those we need in the insurance system so desperately) tend to be very transient and don’t feel the handcuffs of great benefits.nnThe market is changing! The tipping point has arrived (depending on your specific location and your specialty). Health plans no longer want or need a large network of providers. They never did need a large network they just tolerated it for patient convenience and for rate pressure. The trouble with allowing large networks for so long (especially in a market that is more PPO than HMO) is that it is hard to dismantle it. Employers and more so patients have enjoyed having a lot of choice. Today (the tipping point) employers and patients pay more attention to the intolerable cost of premiums! Rates are out of control!nnIf and when a payer can shrink its network they will, especially if the payer can take credit for it. (“look at us, we dropped the most expensive providers from our network” or “We have identified for you the most expensive providers with our rating system”) Once upon a time providers could (and some did so successfully) get together in larger groups and use market dominants to demand higher fee-for-service reimbursements. Today (with some latitude to the specific market) that strategy only allows a health plan an excuse, the chance and the positive public relations to shrink its network size and push more volume into fewer providers.nn
Change always brings opportunity: The fee-for-service “beat our chests” and demand more days are over for most specialties, especially those which are in abundance. Such chest beating will simply play into the hands of the payers who are looking for an excuse to shrink their big networks.nnThe real opportunity exists in looking not at the rates providers receive but rather at the much larger overall Spend. Physicians receive roughly 16% of the Spend on any case, diagnosis, course of treatment (rough number). Physicians (and other provider colleagues) have, however, control of the other 84% of the Spend! Control it, take credit for its control and demand a piece of the larger number! The play is not in trying to make the smaller number bigger…The real play is getting a piece of the larger number.nnMore to come…
Y93.61 — Activity, American tackle footballnnY93.62 — Activity, American flag or touch footballnnW21.01XA — Struck by football, initial encounternnW21.81XA — Striking against or struck by football helmet, initial encounternnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to