For Therapists: The Five Ws of ICD-10


October was the official rollout of ICD-10. The 36-year-old system used for coding diseases, diagnoses and clinical procedures was due for a revision; actually, a federal mandate called for the switch from ICD-9 in the Fall of 2014, but approved an extension because of the sizeable learning curve medical coders have in navigating this update. There are over 120,000 new codes in the revision. Unless healthcare employers have medical coders fluent in ICD-10, they can expect a significant drop in productivity.

Therapists can treat this short list of ICD-10 facts like a palm card, if and when a colleague asks what this switch is all about, and whether it's going to affect their healthcare employer.

  • WHO IS switching to ICD-10? Medicare, Medicaid and most private insurers have to; so does HIPPA. Who ISN'T: Eventually all entities that pay out healthcare benefits will make the transition; but, for now workers compensation and auto insurers don't have to switch to ICD-10.
  • WHAT happens to patients who received services before 10/1/15, but were not discharged and billed for these until after this date? It can get a little tricky, but so long as a patient was discharged from the rehab center or skilled nursing facility before October 1st, his or her bill was not subject to the new ICD-10 codes.
  • WHERE can therapists find published guidelines? *The ICD-10 was developed and is maintained by The World Health Organization and National Center for Health Statistics at the CDC.  Interested therapists can read full guidelines online at the CDC website.
  • WHEN can therapy services be billed with ICD-9 codes? If the therapy was provided before October 1, 2015, it will be billed using the old codes.
  • WHY are we making this transition? This question is addressed at length on APTA's ICD-10 page, but here is the short version: Because it wasn't optional. ICD-9 was developed in 1970, and based on medicine and technology no longer in use. The old version simply lacked the detail needed to bill for today's physical therapy and other allied health treatments.Yes, all of this ICD-10 explanation seems like a lot of fuss for just 2 different code sets (Clinical Modification and the Procedure Coding System), but because so many allied healthcare professionals work in outpatient settings, it behooves them to know more about the switch. While it's a non-issue for Travelers, it still behooves occupational and physical therapists to learn all they can about ICD-10, by exploring the live webinars and other resources the *APTA makes available.

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*Facts about ICD-10 presented in this blog were taken from APTA's page: Top Resources for Your Transition to ICD-10. The Five Ws were gleaned from the *APTA's FAQ page on understanding ICD-10.