Do you really understand the problem?
Diagnosis codes are used to substantiate and support a healthcare provider’s actions. Without the appropriate diagnosis code, a radiologic or laboratory procedure will not be paid.
Referring physicians, case workers, management systems and hospitals will be providing imaging centers and radiology billing services with the new ICD-10 and ICD-10-PCS codes intermixed with CPT and ICD-9 codes, or worst yet a short description of the working diagnosis. Your staff’s attempts at pre-cert, insurance verification and LCD/NCD/CCI checks may require the ICD-10 and ICD-10-PCS codes to be converted back into CPT and ICD-9 codes. Then to submit the claim, you must convert to a CPT code and either an ICD-9 or ICD-10 code to match the requirements of each individual payor. The secondary insurance may even have different requirements than the primary. Oh, and rumor is CMS and others plan not to pay on those claims substantiated by the ICD-10 codes ending in “0 or 9” as these diagnosis codes are considered too nonspecific.
Do you really understand the magnitude of the problem? We do!
RadPayor V-10 Solving radiology’s problems!