Billing Problems Caused by ICD-10 Transition and How Employees Can Minimize Them

It’s been six months since we reported on how U.S. providers were required to implement the new International Code of Diseases (ICD), version ICD-10, which is used to report medical diagnosis and inpatient procedures. While PCMI and most providers have adjusted to the transition smoothly, some unfortunately have not. This is causing headaches for employees and employers who are experiencing billing issues as a result of the transition. Read on to find out what the problems are and how they can be minimized moving forward. 

What are the Problems?

Using the outdated ICD-9 code system. When providers use the older ICD-9 billing code system, it can cause a delay or denial in patients receiving authorizations for certain tests or procedures. Incorrect bill coding can also cause a delay in the payment of health care bills.  

Using wrong codes for preventive screenings. When an employee visits their provider for a preventive screening and the physician diagnoses and/or treats another health issue(s), many employees are unaware that it results in a separate billing charge. Remind employees that treatment of current health conditions are not considered preventiive. According to the preventive medicine coding updated by the American Academy of Pediatrics, a patient can have a discussion with their physician and as long as an office visit does not require additional work and the key components of a problem-oriented service – the provider should not use an additional billing code beyond the screening billing code.

Another problem can occur if a provider conducts a preventive screening on a patient but does not use the proper diagnosis code. This will result in the patient being charged for the office visit. 


Steps to Minimize Future Billing Coding Issues

To help your employees reduce billing problems caused by the transition to the ICD-10 coding system, here are some tips:

  • Recommend employees confirm that their primary care physician’s office is using the new ICD-10 billing codes.
  • When seeing a provider specifically for a preventive screening, encourage employees to communicate clearly to the doctor regarding covered services so they do not incur additional charges.
  • Ensure that employees know that preventive screenings are not time based. Whatever time it takes to complete the procedure is included in the screening visit in the event their physician bills them for additional office visit time.
  • Employees should familiarize themselves with what age-appropriate preventive screenings are covered under the ACA by checking out the Health and Human Services fact sheet.