Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS, CDC Add More than 5,000 Codes to ICD-10 Coding System

The reason that there has been such a large rise in codes for the ICD-10 coding system is due to a partial freeze that occurred before the implementation deadline on October 1, 2015.

By Vera Gruessner

Last week, the Centers for Disease Control and Prevention along with the Centers for Medicare & Medicaid Services (CMS) announced some major news for the ICD-10 coding system. The two organizations have added more than 5,000 new ICD-10 diagnosis codes to be used in healthcare claims next year, according to the American Hospital Association (AHA).

Healthcare providers and payers searching for these new ICD-10 diagnosis codes can find the necessary changes on the Centers for Disease Control and Prevention website. In addition to these 1,900 codes, CMS has published an extra 3,651 new ICD-10 codes to count for inpatient procedures in 2017.

“The AHA is grateful that the Centers for Disease Control and the Centers for Medicare & Medicaid Services have provided an early release of the thousands of new ICD-10 diagnosis and procedure codes to be implemented October 1, 2016,” Nelly Leon-Chisen, AHA Director of Coding and Classification, said in a public statement.

The reason that there has been such a large rise in codes for the ICD-10 coding system is due to a partial freeze that occurred before the implementation deadline on October 1, 2015. All new and revised ICD-10 diagnosis codes are available on the CMS website.

“The clinical modification represents a significant improvement over ICD-9-CM and ICD-10,” according to the Centers for Disease Control and Prevention. “Specific improvements include: the addition of information relevant to ambulatory and managed care encounters; expanded injury codes; the creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition; the addition of sixth and seventh characters; incorporation of common 4th and 5th digit subclassifications; laterality; and greater specificity in code assignment.”

Ever since the ICD-10 coding system was implemented on October 1, 2015, healthcare providers have actually seen relatively small rates of claim denials due to coding issues, which is the opposite of what many healthcare stakeholders feared.

RelayHealth Financial announced in a press release about one month ago that the denial rate associated with the ICD-10 coding system. Out of 262 million medical claims, only about 1.6 percent had been denied. The report analyzed claims data that encompassed $810 billion.

RelayHealth Financial finds that this denial rate has not changed since November 2015 and it represents a total of $12.9 billion in denied reimbursement since the implementation date on October 1.

Any health care providers that are struggling with meeting the demands of the new ICD-10 coding system are advised by relayHealth Financial to access in order to overcome the obstacles and achieve the solutions necessary to prevent claim denials due to ICD-10 coding issues.

This particular website has a number of features including white papers, case studies, and a webinar that can assist providers in learning about a number of best practices to reduce their claim denial rates. The 1.6 percent claim denial rate came from analyzing 630,000 healthcare providers and 2,400 hospitals.

Low claim denial rates due to scant ICD-10 issues seem to be coming across multiple organizations. Along with RelayHealth Financial’s results, CMS announced that their claim denial rate due to ICD-10 problems was a mere 0.07 percent in the last three months of 2015.

Medical claims rejected due to ICD-9 coding at CMS also amounted to 0.07 percent during the last quarter of 2015. While there may seem to be more providers who have successfully transitioned to the ICD-10 coding system and went without many claim denial rates, a survey from Porter Research and Navicure found that approximately 33 percent of those polled saw their revenue drop by as much as 20 percent.

Only about six out of ten survey takers did not experience any impact on their overall revenue after the ICD-10 implementation deadline passed. While not all denials were related to the new ICD-10 coding system, CMS did deny a total of 9.9 percent of medical claims submitted during the fourth quarter of 2015.

Nonetheless, the majority of providers were still well-prepared for the ICD-10 implementation date and CMS did assist medical organizations with any problems that occurred after the October 1 deadline.

Instead of the disaster that many feared would occur to the revenue of hospitals and providers, most were ready to take on the challenges of the ICD-10 coding system once it was in place. Now medical facilities will need to adhere to the revised codes that CMS and the Centers for Disease Control and Prevention have released.

As healthcare organizations continue to manage the reformed payment landscape, medical billing and claims processing will remain integrated with diagnostic coding, which means adhering to new and revised ICD-10 codes will be essential throughout the medical industry.

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