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5 ICD-10 Regulation Myths

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Leaders from AHIMA shared their insights about ICD-10 regulations at the organization's national conference, according to Government Health IT.

Here are five myths about ICD-10 regulations and the truth behind each misconception.

1. GEMs can be ICD-10 substitutes. General Equivalence Mappings are only guidelines and are not intended to substitute for ICD-9-CM and ICD-10/CM/PCS directly. They can be a helpful took for database conversions, but they are not intended for coding medical records. You get less than you pay for with GEM-only solutions because they do not include real-word usage.

2. ICD-10 World Health Organization is the same as ICD-10 PCS. The version of ICD-10 being adopted in the United States is not the same as in other countries. While the World Health Organization collaborated with the U.S. on a specific version for our country, it is not the same as the WHO version used in other countries. If vendors say they are ready for ICD-10 because they downloaded it from the WHO site, they are incorrect. You need ICD-10 PCS for procedure coding, billing of inpatient procedures and reimbursement.

3. EMR, claims vendors will make your organization ICD-10 compliant. Businesses, not vendors, are responsible for the ICD-10 transition and any potential risks associated. A healthcare IT vendor who is compliant cannot accomplish a compliant transition for any payor or provider.

4. EMRs are completely separate from ICD-10 data. Linkages between EMR vendor assessments, documentation and coding will have to be strengthened during the ICD-10 transition. ICD-10 is how inpatient data will be expressed through the entire process, from diagnosis to procedure.

5. RAC audit risk is unaffected by ICD-10 CM for outpatient claims. CMS' Recovery Audit Contractors work to recover inappropriate Medicare payments, and about 73 percent of automated denials were from hospital outpatient services. Though outpatient and ASC services will be billed in CPT, the diagnosis must be expressed in ICD-10 CM on or after Oct. 1, 2014. Without using ICD-10 CM, future RAC audits will increase the risk of claim denial.

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