If you work with insurance in your private practice, you already know how intricate that billing process can get. Each year, the Centers for Medicare & Medicare Services (CMS) release updates to ICD diagnosis and procedure codes. It’s critical for you to stay on top of these changes and monitor if and how they’ll affect your billing in the coming year.
Why ICD Codes Matter
Standardized diagnosis codes across the healthcare industry make it easy for any provider or insurance company to recognize a client’s diagnosis, and are a necessary part of getting insurance companies to pay for certain treatments.
ICD codes are also an important tool for gathering data in the healthcare space. The updates made to the ICD-10 codes specifically will provide researchers with higher levels of clinical details and improvements in treatment technology. In turn, that data will have an impact on healthcare policy, treatment recommendations, and resource allocation, among other things.
What’s New in 2021
CMS just released their updates to the ICD-10, which will apply to all services performed between October 1st, 2020, and September 30th, 2021. The changes this year include the following:
490 new diagnosis codes, including new codes for alcohol and narcotic use disorders, fentanyl poisoning, vaping use disorders, accidents involving electric scooters, and COVID-19.
58 deleted codes, including poisoning from synthetic narcotics. These deleted codes will be replaced by new ones. For example, code R51 (headache) has been deleted and replaced by newer and more specific codes.
47 revised codes, including updated descriptions for Z68.XX codes about adult body mass index (BMI) and Z88.X codes about allergies.
How It Impacts Your Practice
Since ICD codes are used across multiple healthcare fields, there’ll probably be a lot of codes in this update that don’t apply to your billing. But, you do want to review this list carefully—if you use a deleted code that’s no longer recognized, or try to use an old version of a code, the reimbursement for that service may be denied.
It also might be worth taking an extra careful look at the new codes surrounding COVID-19 diagnoses. Those codes will be new for everyone, and you’ll want to make sure you fully understand when you might need to use them in your own practice.
If you have a list of the previous codes that you use frequently in your practice, you can use the “Search” Function in documents from CMS to only look directly for what you need. That way you can quickly determine what changes, if any, have been made to your most regularly used codes and make the necessary adjustments to your billing documents.
The world of insurance billing can get complicated pretty quickly. To avoid getting stuck in endless billing conversations, set aside a block of time to go through all the new information thoroughly one time, and get all the relevant information. Then you can be confident that your billing is set up correctly, and spend that time with your clients instead.
Pollen Magazine examines the health and wellness industry through the lens of the professionals that are redefining private practice. Find inspiration, learn from others, and discover insights on how to build the best version of your practice.
Get the latest articles right in your inbox.Join 130,000+ practitioners like you getting the best resources.