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As of October 1, 2015, the new International Classification of Diseases, Tenth Revision (ICD-10) is the required diagnosis code set to be used for billing all claims to insurers. Every healthcare stakeholder is affected by the transition to the expanded ICD-10 code sets, as these changes impact medical coding operations, software systems, reporting, administration, registration, and more for all entities and providers covered by the Health Insurance Portability and Accountability Act (HIPAA), not only those submitting claims to Medicare.
CMS and commercial payers require a valid code to be reported for reimbursement, and it will be important to follow the ICD-10 guidelines to complete the code set. While M05 is a correct category to identify rheumatoid arthritis with positive rheumatoid factor, ICD-10 coding guidelines indicate that at least five characters are necessary for this to be a valid/billable code. A sample of a valid code for RA with rheumatoid factor is M05.79 – rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement.
Understanding the coding guidelines and applying the most valid diagnosis code to your claim will minimize any negative impact on your practice’s financial and operational metrics. The following are key indicators for accurate billing and timely processing.
Keep in mind, the implementation of ICD-10 is only for diagnosis coding and will not affect CPT coding for outpatient procedural services.
Download the ACR crosswalk with the top 50 commonly used rheumatology codes as well as the rheumatology specific superbill to be used as a quick guide for coding and billing. (Note: these should not take the place of the official ICD-10 coding manual as there are key guidelines and convention that may not be included in the crosswalk due to space.)
Additional steps to ensure practice efficiency include:
ACR staff has developed a stronger communication and collaboration platform that can help keep better track of any ICD-10 implementation issues and coding errors before and after October 1. For faster response to questions or concerns, members can send questions to firstname.lastname@example.org.
There's more to ICD-10 than just learning a new code set and upgrading your software as the transition will affect every aspect of your practice. The ACR created the rheumatology-specific training with targeted learning for physicians, coders, billers, and administrators. The workshop includes a concentrated focus on clinical documentation improvement to reach the highest level of ICD-10 specificity by accurately pinpointing problematic terms in ICD-9 and ICD-10, common documentation deficiencies in patient medical records. The goal of the ACR's coding and billing workshop series is to equip rheumatologists and their staff with the necessary tools to achieve coding compliance and attain optimal reimbursement while preventing fraud and abuse. The workshop includes: ICD-9 vs. ICD-10 mapping differences, clinical documentation improvement guidelines, rheumatology specific coding guidelines, ICD-10 coding conventions, ICD-10 case studies, and much more.
Download Registration Form
Coding and Billing
Antanya Chung, CPC, CPC-I CRHC, CCP
404-633-3777, ext. 818
Melesia Tillman, CPC, CPC-I, CRHC, CHA
404-633-3777, ext. 820
ICD-10 Training / Implementation