To comply with the International Classification of Diseases, Tenth Revision (ICD-10), what’s the best way for labs to navigate this new, more extensive coding system? What if they have reimbursement problems? Are there immediate benefits to switching to ICD-10? 

Charles Root, PhD, CEO of CodeMap in Schaumburg, Illinois, addresses these questions and more in the December issue of CLN. Following is an excerpt from Root’s Q&A session:

Q: What should labs do if Medicare does not reimburse them because the ordering physician did not use the appropriate ICD-10 code?

A: If a laboratory submits an ICD-9 code on a claim after October 1, 2015, the claim will be returned as unprocessable. Thus, the only recourse is either to convert the ICD-9 to an ICD-10 or to contact the ordering physician and obtain an accurate ICD-10 code.

Q: How does one convert ICD-9 codes to ICD-10 codes?

A: The General Equivalence Mappings (GEM) files for both ICD-9 to ICD-10 and ICD-10 to ICD-9 are available online from Medicare and numerous other sources. These files tell you whether a given code is directly equivalent to a single code, multiple codes, or only approximately equivalent to one or more codes. Directly equivalent conversions that are unambiguous can always be used to convert ICD-9 codes to ICD-10.

Q: How might labs work with physicians to ensure they use the proper codes?

A: If physicians submit laboratory requisitions with ICD-9 codes, the laboratory should contact them and remind them that only ICD-10 codes are now acceptable for all Medicare and commercial payer claims that the lab submits. Explain that in cases in which the conversion from ICD-9 to ICD-10 is unambiguous—that is, when a one-to-one conversion exists—the laboratory will convert the unacceptable ICD-9 code to the correct ICD-10 code. However, in cases for which a simple one-to-one conversion is not possible, the lab will have to contact physicians for the correct ICD-10 code.

Pick up the December issue of CLN to read more about ICD-10 implementation tips and the potential benefits this upgrade will present to laboratories.