What OT Clients Need to Know About ICD-10

ICD-10 and occupational therapy. GettyImages

If you receive occupational therapy services on Oct. 1st, hopefully, you will notice nothing amiss.

On the backend of your OT services on that day, a major change will be enacted­—the diagnosis codes used by every HIPPA covered entity in the country will be completely overhauled. According to a federal mandate, companies will be updating from the International Classification for Disease (ICD) Version 9 to Version 10.

This means that coding used for billing is undergoing a drastic change.

While this change should not directly impact your services, as a patient, it is worth understanding this change for the reasons listed below.

A Brief Overview of ICD-10

The first version of the diagnosis classification list was called International List of Causes of Death and was adopted by the International Statistical Institute in 1893. In 1948, the World Health Organization (WHO) was created and was entrusted with overseeing and updating the list, which was already in its sixth iteration.

ICD-10 was endorsed in May 1990 by the Forty-third World Health Assembly. The U.S. will be the last country with modern health care to adopt it.

In ICD-10, there are 68,000 existing codes, as opposed to the 13,000 in ICD-9, which means the codes are much more specific. The terminology will be updated from the previous version,  which was adopted by WHO in 1975.

Also, ICD-9 was not originally designed for billing purposes, which it is now widely used for. ICD-10 will be more billing friendly.

Back to how this change may impact you as a consumer:

You May Be Contributing to Research and Public Health Policy

The information in your medical record is closely guarded by HIPPA, which makes gathering information for research projects difficult.

Codes like those in ICD-10 allow the World Health Organization and other entities to track disease data without accessing the details of specific cases. Access to this type of information is particularly important on a global scale for tracking the emergence of potential endemics and planning for public health policy.

The greater detail about injury and diseases will also allow for more detailed research about the prevention of disease and quality of subsequent services.

The Administrative Price tag of the Change May Be Hefty

Critics of the switch to ICD-10 point out that the change will be costly to implement.  New systems and personnel may need to be put into place to ensure that guidelines are properly adhered to for reimbursement. These costs have the potential to shrink further already shrinking margins and to be passed onto the consumer.

The Changing Landscape of Reimbursement

If you have had difficulty getting covered for the treatment of a certain diagnosis, this change is a great reminder that the reimbursement landscape is always in flux.

Particularly, pediatric occupational therapists run into reimbursement difficulty for treatment when a diagnosis is not clear or the treatment does not have enough evidence to back it.

Changes like the update to ICD-10 may be a good cause to call your insurance agency or local therapy clinic to see if these changes may eventually open doorways for new codes to be approved for reimbursement.

Pay for Performance and Big Data

This change is consistent with the trend that you will see throughout the health care sector. There is a push to be collecting more and more data, about patient conditions, treatment, and outcomes. One of the ultimate hopes for big data is that it will inform changes in reimbursement allowing for rewarding the quality of services delivered instead of the quantity. 

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