Douglas L. Beck, AuD, speaks with Burns about Medicare, Congress, ICD-9, ICD-10, ICD-11, and more.
Beck: Hi, John. I know you have many unusual and interesting credentials and training with regard to billing and coding. As such, let’s start by briefly reviewing your qualifications as a billing and coding expert?
Burns: When I completed my studies in health science, I moved to Atlanta and began working for a consulting firm that required certain credentials to serve its clients. I obtained my certified professional coder (CPC) certification first and then worked to become a certified instructor with the AAPC (CPC-I). As I became more involved in helping physicians and other health-care providers though audits and educational efforts, I began to realize the need to master evaluation and management (E&M) coding; a set of codes that were obviously subject to more scrutiny than other types of service. That was the reason I decided to obtain the Certified Evaluations and Management Coder (CEMC) credential. And then once the AAPC launched its Certified Professional Medical Auditor (CPMA) credential, I knew it was something that a consultant in my line of work simply needed to demonstrate the requisite skills necessary to audit medical claims and assist providers during payer pre-payment and post-payment reviews processes.
Beck: Thanks, John. I’d like to learn a little bit about the ICD-9 and ICD-10 issues. First of all, what does ICD stand for?
Burns: International Classification of Disease (ICD). ICD-10-CM is simply the 10th Clinical Modification. ICD dates back to the 1890s and was primarily intended to track mortality around the world. I first heard of ICD-10 back in the mid-1990s. It has been used in most industrialized nations since as early as 1994 and was set to take effect in the United States on October 1, 2015, after multiple delays. On July 6, 2015, CMS announced a one-year lenience period where Medicare will not audit ICD-10 and will process claims in a non-punitive manner so long as the codes selected are in the ballpark, so to speak.
Beck: Okay, and so ICD-10 seems to be on-again/off-again. No news there! When was ICD-9 implemented, and when do you think ICD-10 will finally be launched?
Burns: ICD-9-CM was introduced in the mid-1970s but was not necessary on physician claims for reimbursement until 1988. You see, professional physician services are paid based on relative value units (RVUs), not diagnostic parameters. Unlike hospitals and facilities (e.g., DRGs), the ICD-9-CM codes are simply used to describe “why” providers have performed a service and assist in establishing the medical necessity for service(s) performed.