In preparation for the conversion to ICD-10, the 10th revision of the International Classification of Diseases, you should “review and compare current ICD-9 reimbursement policies for both your commercial and Medicare payers,” according to the Ambulatory Surgery Center Association (ASCA).
“Conditions deemed medically necessary in ICD-9 might not translate to medically necessary conditions in ICD-10,” ASCA said. The Centers for Medicare and Medicaid Services (CMS) “can provide your facility with many state-specific ICD-10 draft policies pertinent to your Medicare volume.” To access the CMS information, go to http://go.cms.gov/1M1yA2T.
Mark Mayo, CASC, executive director of Golf Surgical Center in Des Plaines, IL, says Medicare relies on Local Condition Determinations (LCDs) that seem to vary in what is covered and in what is required for documentation. “ASCs and HOPDs [hospital outpatient departments] will now also need to obtain new draft policies and coverage lists from many other insurers, such as Blue Cross,” Mayo said.
Oct. 1, 2015, is the new date for healthcare providers, health plans, and health care clearinghouses to transition to ICD-10.