Adapting to ICD-9 and Other Coding Changes in Your Practice

As the calendar moves forward to a new year, changes follow for medical practices as well. We must adapt to the change by updating our practice management systems to include the changes to ICD-9, CPT, and new rules by CMS and insurance payers. 

The present, but outdated, ICD-9 list of diagnosis codes receives the annual changes with new code additions, modifications, and deletions.

Just as medical practices become accustomed to a routine work flow of utilizing their most commonly used ICD-9 codes, we must keep current with such modifications. Using older or deleted codes results in claims being held or denied completely. This can pose quite a hurdle for practices because it can place a damper on cash flow.

The CPT codes also change with each new year. Fortunately most codes stay the same, but practices must review their current practice management databases to ensure that they are using the proper procedure codes because delays in payment or denials of claims can result with the submission of improper codes.

Such changes with ICD-9 and CPT codes have been commonplace for several years and will almost assuredly continue, even with the adoption of ICD-10 in 2013. The cost of staying current can also be quite expensive since the new codes are listed in manuals purchased from the AMA or provided in updates from practice management software vendors.

One particular new benefit that medical practices will see this year is the annual health maintenance examination allowed by CMS. For all patients with Medicare, an annual physical examination is now provided to each beneficiary at no cost to the patient in terms of a copayment or a deductible.

This will be a welcomed benefit for practices such as mine that have a high percentage of Medicare patients. In the past, Medicare patients had no such benefit and the process of providing health screenings was simply incorporated into a routine office visit. For those of you that care for elderly patients, the process of reviewing routine medical problems and updating medications as you know can be a most laborious process and providing adequate health maintenance was essentially provided to those patients as a bundled or non-covered service. Since physicians cannot bill for the time involved in scheduling screening tests (such as mammograms, pap smears, etc.) when a patient is not present in the office, this new benefit will improve the bottom line.

The years to come will bring many new changes and regulations set forth by the Affordable Care Act. As medical practices modify their coding and billing processes, one can only hope that the newly provided benefits and reimbursements for services provided to the patients can adequately cover the increasing costs and time that physicians have invested.