Mental Health Billing and the ICD-10

Back in August, the U.S. Department of Health and Human Services (HHS) posted a proposed rule requiring the implementation of the portion of HIPAA that mandates use of the ICD-10 by October 2011. The International Classification of Diseases-10 was endorsed by the 43rd World Health Assembly in 1990 and was implemented by many World Health Organization (WHO) member states as early as 1994. The United States is 14 years behind the curve on use of this updated version of the ICD, the list of diagnoses used in all medical billing. As more healthcare organizations implement electronic medical records (EMRs) ICD diagnostic codes are used ever more widely, but at present payment for health services is still the most important function of these codes in the U.S.

There was an immediate outcry from provider and payer organizations that the 2011 date was too soon. The Medical Group Management Association, the American Medical Association and America’s Health Insurance Plans registered objections with HHS over the implementation date indicating that the costs would be too great for providers and payers, especially given the recently completed and very costly implementation of the NPI (National Provider Identifier).  But now, the American Hospital Association has supported the 2011 date suggesting that the potential gains from use of the ICD-10 are too great to wait any longer to implement the new codes.

We know the pain that has been experienced by customers of Synergistic Office Solutions in adopting the NPI and continuing to get paid for services rendered. Our software has been able to handle the NPI since early 2007, but some of our customers still struggle with the confusion caused by this transition.  While software can be made ready for the ICD-10 without very much difficulty, we are concerned about how this change will be handled in the real world by psychologists and psychiatrists and social workers who are accustomed to using the DSM-IV and ICD-9 for diagnoses for mental health conditions.

What do you think about a move to ICD-10? Do you expect this next round of changes required by HIPAA to be simple? to be problematic? What do you expect the impact will be for your organization and how do you plan to handle it? What is the best way for vendors of mental health billing software and medical billing software, medical EMRs and behavioral health EMRs to assist providers in implementing the new ICD-10 codes? Let us know what you think. We want to help make this new transition as smooth as possible.

0 thoughts on “Mental Health Billing and the ICD-10

  • How hard could this be? Won’t most of the codes be similar to what they are now? Will SOS be able to distinguish what is what and update accordingly or will this have to be a patient by patient change? Or am I completely not understanding what the ICD-10 is all about?

  • I agree, how hard can this be – give MD’s the ICD-10 sheet, and enter the ICD code into the program. Am I missing something also?

  • That’s how it should work, but consider the following:

    1. The ICD-10 has an additional character and many software products do not have enough spaces in the diagnosis and procedure code fields to handle it. While the SOS database can accomodate to the change, many billing programs will not be able to do so. Some providers will need to buy new software or pay for upgrades.

    2. Many payer adjudication systems are much more rigid than billing software. Consider the complications of a huge payer who must completely revamp their system to accept the new codes.

    3. Some of our users struggle with the crosswalk from the DSM-IV to the ICD-9 where most of the codes are identical. The new codes will not look like the old ones.

    4. SOS for one has avoided changing diagnostic codes because many providers customize their lists. Any changes the software vendor makes overwrite user customizations.

    5. Even if the software vendor were to create a crosswalk, there will always be details that the user must handle. Providers will need to educate themselves about the new system, use the new codes, and make the fine decisions among competing choices.

    6. This is much more complicated than the NPI.

  • I think there are two issues here. The first, the more simple one from our standpoint, is the entering of the ICD-10 code into the billing system. That should be relatively simple assuming that SOS has upgraded its software to accommodate the new codes. The harder part is that ICD-10 is completely different from ICD-9. Different numbering system, some possible different names for diagnoses, etc. The training all of us will need to understand ICD-10 is the greater problem. If SOS will upgrade, at a reasonable cost (I’ve heard of estimates from HHS of between $85,000 to $250,000 per provider), then it will be up to us to find or develop the training in how to use ICD-10.

  • Kent Eichenauer says:

    I know that ours is a small practice of only 4 providers, but it seems to me that, especially if the AHA is behind this, there’s not a whole lot of choice. I know SOS has always made things as user-friendly as it can. Maybe I’m just in denial, and I understand this can be more complicated than the NPI, but at least we don’t have all the codes that a family practice MD would have.

  • Small practices will be hard hit unless there is some sort of online training available. With HIPAA everything went smoothly until May 23 when Medicare decided to crosswalk NPI to tax id in their records. Since most MD’s signed up right out of residency, they put their SS# and over the next 20 or so years forgot that fact. With ICD-10, we should be able to learn next year the changes (hopefully) if the information is put out there to learn.

  • There will be no additional software cost for SOS customers who maintain support contracts. (If there is no public domain source for the ICD-10 codes and descriptions, SOS would probably create an import utility and tell you where you could purchase a suitable file containing the data.) The adjustment of field lengths, and even adding a new Dx category, with the ICD-10 codes pre-loaded, is no big deal technically. As Kathy points out, however, the implementation hurdles are likely to be tied up with payor implementation schedules. Consider, for example, that you have a patient with primary coverage with Payor One and secondary coverage with Payor Two. Let’s say that Payor One mandates use of ICD-10 starting on June 1, but Payor Two won’t be ready until September 1 and requires the ICD-9 codes until then. Somehow you would have to maintain TWO sets of diagnoses for your patient and designate the set that should be used for which payor when. Lordy, what a headache! I would hope that there will be a fairly long transition period during which either diagnosis will be accepted, and a firm deadline for ICD-10 only. In practice, what that will mean is that nobody will use the ICD-10 until the deadline to avoid problems with payors that are not ready. This situation is the NPI all over again, and after seeing the chaos resulting from THAT change, I am not expecting an easy changeover.

  • This whole diagnosis code situation is difficult, even now. I have a terrible time keeping track of which codes require 5 digits, and which 4. I think insurance companies are delighted to find some wrinkle by which they can avoid payment to clinicians. My wish would be that we could be provided with a file that we could choose to use, overwriting what we had already had, or not. This is my wish, with or w/out the swap to ICD 10.
    That said, sounds like ICD 10 will be complex. I heartily second the notion of long and flexible implementation, with no company allowed to reject claims until all – or at least all major ones – are ready to use the new set- up.
    Best – Ann Aukamp

  • I am thankful I paid my support agreement. This is just another way to try to cause trouble getting paid. We will manage like we did with the NPI. I will put Noe on speed dial now.

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