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Worker’s Compensation, PC Providers & Insurers to Use ICD-9 & ICD-10

  • by Margaret Klasa DC, APN BC
  • Sep 28, 2015, 11:20 AM

iStock_000024136466MediumOctober 1, 2015, and beyond will certainly bring on the challenges for both providers and payers – from revenue cycle complications to compliance and technical issues that will be a hurdle to overcome on both ends of the payer and provider sides. Some segments of the insurance industry are not required to follow suit and transition to the new ICD-10 coding set, however that does not mean they will be untouched by this transition and will spend an increased amount of time sorting and identifying ICD-9 codes from the rest of the industry’s new ICD-10 codes.

The Health Insurance Portability and Accountability Act (HIPAA) which is a federal mandate requiring the use of ICD-10 coding on October 1, 2015, for all Covered Entities, however, state regulations allow for Auto, Property and Casualty insurers and Workers’ Compensation to still use ICD-9 codes in the newly created ICD-10 world.So how will the staff respond when claims from a provider or a claimant have a mixed set of ICD-9 and ICD-10 codes being submitted? Not bothering to learn the new ICD-10 code set or cross-walk any of the ICD-9 thinking you are not required to?

A slowdown in workflow is anticipated with ICD-10 and now staff will have to manage two sets of codes – ICD-9 and ICD-10. Revenue will be impacted with ICD-10 and most importantly the time staff has to spend to work through the federal and state requirements. Vendor systems may not be able to handle dual coding systems. And any cross over billing may become unmanageable.

Context4 Healthcare's ICDTransformer™ can help you to manage your ICD-9 and ICD-10 claim code sets before it takes up the majority of your staff’s time. Our ICDTransformer™ encompasses:

  • State-of-the-art technology that uses a proprietary knowledgebase created by our highly experienced clinical coding team
  • Unique methodology reviews the ICD-9 codes your staff is accustomed to, identifying key pieces of the service to pick the proper ICD-10 code – this means no immediate changes or disruption to office policies or productivity
  • Not just the correct code is provided but the correct Include and Exclude codes as well
  • The ICDTransformer™ analyzes: ICD-9 diagnosis, the rendered service, laterality and body part 
  • Search words provided by the user

About Context 4 Healthcare, Inc.

Headquartered in the Chicago area, Context has more than 25 years of experience in software & data product development. Our solutions impact more than 4,000 clients & tens of millions of lives globally. Context’s solutions have been developed to address the industry challenges currently faced by healthcare payers & providers:

Our online real-time claim editing software contains millions of edit combinations identifying inaccurate billing practices, regulatory requirements & other errors. Delivered in a software as a service model, our editing is easily implemented.

Context produces a proprietary usual, customary & reasonable (UCR) fee schedule by analyzing billions of charges annually covering the U.S. & territories. Our nationally recognized UCR database identifies appropriate fees for millions of procedure combinations.

Our 100+ data products are a one-stop shop for your data & coding challenges, & provide the code sets required for accurate claim processing. Our proprietary ICD-10  solutions include crosswalk databases & our server-based ICD-10 compliant coding software.

For related reading, check out this blog article: Context 4 Healthcare, Inc. Can Solve Your GEM of an ICD-10 Problem

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