Last October, the industry switched from the old ICD-9-CM coding system to a new system classified as ICD-10-CM. This updated system is used to code and classify symptoms, diagnosis, and procedures performed on patients. And, just maybe, for right now, payments have sped up a bit under the new coding system.

So Far A Faster Payment Process

90-day data points seem to suggest payment is faster under ICD-10. According to onPoint Principal (and coding guru) Bobbi Buell:

Well, I need to say that the switch to ICD-10-CM has sped up the payment process--or so it seems. Our company has a database of cancer drug claims/EOBS from about 262,000 lives in 2015. We looked at days to file ("DTF") and days to pay ("DTP") for 2015 ICD-9 claims versus ICD-10 claims from October  to date. These are the top 10 WORST Days to Pay insurance companies (with more than 10 paid claims) in terms of DTF and DTP---notice that many have IMPROVED under ICD-10 data so far. Weird, but again, this can be due to the smaller data set. I prefer to think of it as good work, offices!

Name	ICD 9 DTF	ICD 10 DTF	ICD 9 DTP	ICD 10 DTP
CAREMORE IPA	9	6	83	49
PEOPLES HEALTH NETWORK	14	7	57	49
WELLMED	9	4	102	48
BASIC HEALTH	40	21	35	47
HEALTHSCOPE BENEFITS, INC.	6	8	52	46
ST. JOSEPH HERITAGE HEALTHCARE	5	5	25	45
VETERANS ADMINISTRATION FEE BASIS PROGRAMS	47	6	50	45
UNITED MEDICAL RESOURCES	22	8	51	45
MANAGED HEALTH SERVICES - INDIANA	23	35	36	43
BROWN AND TOLAND MEDICAL GROUP	11	10	49	41
CALIFORNIA MEDI-CAL	13	24	112	40

 

We are seeing the same thing with drugs. You control Days to File and these have gotten better--the Days to File are actually improved over ICD-9-CM. Here are some examples of cancer drugs that have had some delays in terms of Days to File. Some of these drugs have new J-codes, so you would expect improvement, but most of our data is from 2015...Again, there is less time for bad accounts to accumulate--but, still good job getting those claims in!

Brand Name	ICD 9 DTF	ICD 10 DTF
Keytruda	16	9
Cyramza	19	8
Opdivo	17	8
Zevalin	13	9
Yervoy	11	8
Provenge	20	10
Xofigo	25	8
Ixempra	10	10
Jevtana	9	6
Arzerra	10	8

 

ICD-10-CM: What’s New

The ‘improvements’ each group sees from ICD-9-CM vary by specialty and patient mix.  Overall ICD-10-CM now consists of over 68,000 codes as opposed to ICD-9-CM, which only contained 13,000 codes.

Some of the other features that have been implemented in this new classification system include: the ability to easier describe a patient’s condition through combination symptom and diagnosis codes as well as injury codes and codes that are helpful for ambulance and managed care encounters.  Again, if we are talking about Oncology, there are not a super, duper number of improvements

Another important addition with ICD-10-CM is the ability to code which side of the body, right or left, has been evaluated or treated.  Some payers will require that the side of the body is specified for say, lung cancer or breast cancer.

 

Keep Track with focalPoint

With the help of our product focalPoint, you can keep track of all of your data to see the difference that ICD-10-CM has made to your business.  Some of these benefits might include decreased Days To File and Days To Pay resulting in a quicker process for patients.  Some of the the drawbacks may include the requirement for right and/or left specificity on the claim.  This may increase the denial rate for your product or service.

Our clear presentation of data and metrics will allow you to have the best picture and recognize opportunities and challenges that occur with the new system.  If you would like to learn more, contact our team today!