Why physicians will be using ICD-9 codes after Oct. 1

Carl Natale
by Carl Natale
Why physicians will be using ICD-9 codes after Oct. 1

Despite Centers for Medicare and Medicaid Services (CMS) efforts to resist legislative delays and dual coding proposals, ICD-9 coding will still have a place in U.S. healthcare next month.

According to CMS, "All Health Insurance Portability and Accountability Act (HIPAA) of 1996 covered entities MUST implement the new code sets with dates of service, or date of discharge for inpatients, that occur on or after October 1, 2015."

That covers just about every healthcare provider and payer. But there are non-covered entities such as worker's compensation, disability and auto insurers that are not required to switch.

"... coverage for accident, or disability income insurance, or any combination thereof; coverage issued as a supplement toliability insurance; liability insurance, including general liability insurance and automotive liability insurance; workers’ compensation or similar insurance; automobile medical payment insurance; credit only insurance; coverage for on-site medical clinics; other similar insurance coverage,specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. See 42 U.S.C. 300gg-91(c)(1)."

Generally, if the non-covered entities don't want to switch to ICD-10 coding, they don't have to and can require healthcare providers to submit medical claims with ICD-9 codes.

Except when it comes to workers' compensation. That is regulated by the states. And some states do require ICD-10 coding for those non-covered claims.

Recently, the International Association of Industrial Accidents Boards and Commissions (IAIABC) surveyed the states and created a detailed spreadsheet explaining each state's ICD-10 requirements. Workgroup for Electronic Data Interchange (WEDI) has released the information in a spreadsheet.

[Download: WEDI ICD-10 State Workers’ Compensation Readiness List]

According to the WEDI list, the following states have adopted ICD-10 coding for billing:

  • Alabama
  • California
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Nevada
  • New Mexico
  • New York
  • North Carolina
  • Ohio
  • Oregon
  • South Dakota
  • Texas
  • Washington

Indiana, Maine and South Carolina have mandated ICD-10 codes for hospital inpatient billing only. Which means that physician practices will have to keep using ICD-9 codes for workers compensation claims and ICD-10 codes for just about everything else. Not the best scenario for them.

According to WEDI, this has resulted in five workers' compensation ICD-10 readiness scenarios:

  1. "States that have adopted ICD-10 regulations with the effective date of Oct 1, 2015"
  2. "States that have pending ICD-10 regulations with no defined effective date when these regulations will be finalized"
  3. "States that have adopted ICD-10 however only for specific Claim Types Identified"
  4. "States that are not adopting ICD-10 as it is not relevant to theirregulations/ fee schedule andor are allowing voluntary adoption. In this scenario most states highly recommend stakeholders support ICD-10"
  5. "States that do not have statute authority to regulate the use of International Classification of Diseases codes.In this scenario the ICD-10 determination is to be made by the individual payer for that state"

Basically, medical practices need to check with all healthcare payers to find out how to submit claims. It's not going to be fun to have to keep track of two types of medical claims.

This shouldn't last. Data is like oxygen to insurance companies — HIPAA covered and non-covered entities. It's hard to believe they won't be eager to start accepting ICD-10 claims as soon as possible.