In October 2013, the U.S. health care system will begin using the ICD-10-CM and ICD-10-PCS code sets. While the switch is not mandatory for the workers’ comp system, “system stakeholders, including state agencies, mono-line insurers and bill review companies cannot afford to overlook the conversion,” the organization said.
“Given the small percentage of workers’ compensation clients that medical providers see, maintaining an electronic billing system with two coding sets would be impractical and costly,” the IAIABC said. “Delayed bills from workers’ compensation carriers who cannot accept ICD-10 might force providers out of the system and restrict quality care to injured workers. This would cause more than a few headaches for state agency CEOs, insurance executives and medical providers.”
The IAIABC has urged state agency directors to familiarize themselves with the impact of ICD-10 on their agencies and stakeholders. ICD-9 codes can be referenced in statutes, administrative rules, fee schedules, and/or treatment guidelines.”Given the length of time generally required to update an administrative rule, states that haven’t closely examined their rules or regulations are behind,” said Jennifer Wolf Horejsh, IAIABC’s incoming executive director.
The organization also points out that states will be required to report to the Centers for Medicare and Medicaid Services using ICD-10 codes. In a recent IAIABC survey, nine states indicated concerns about data reporting requirements, including those that report second injury fund data to CMS.
Despite some challenges, the conversion to the ICD-10 codes can benefit the workers’ comp community, according to the IAIABC. It notes that the greatly expanded code set can:
Allow for much greater specificity and accuracy in diagnosis.
Aid in the development of fee schedules and pricing schemes.
Help in managing the utilization review process.
Provide an opportunity for greater measurement of the quality and efficacy of medical care.
“Stakeholders will certainly identify ways to use this information in new and powerful ways,” the IAIABC said. “However, they must first prepare for an efficient and seamless transition process.”
Read more at the WorkersComp Forum homepage.
October 3, 2011
Copyright 2011© LRP Publications
