Self-Funded Plans and ICD-10: What Are They?

ICD-10 – even its name is in code

ICD-10 is the International Classification of Diseases, Tenth Revision.  Essentially ICD-10 is the diagnosis code set used by health care providers to indicate a diagnosis of a patient so that health insurance can be appropriately applied.

So long old friend.  ICD-9’s last day was September 30, 2015

ICD-9, ICD-10’s predecessor, was implemented in 1979.  The American Medical Association’s website states that ICD-9 had become outdated.  The 14,000 numeric-only code set was “no longer considered usable for today’s treatment, reporting and payment processes, and it did not reflect advances in medical technology and knowledge.”

The AMA further expresses that “The ICD-10 code set reflects advances in medicine and uses current medical terminology.”  ICD-10 format includes 68,000 alpha-numeric codes to provide more specific information about a diagnosis.  Also, the ICD-10 code set can be expanded as new technologies and diagnoses are deemed appropriate to add to the set list.

The transition

The change from ICD-9, however, is expected to be disruptive for physicians, insurance companies, and employers.  There was a hard cut-off date of September 30 for using ICD-9.  Starting October 1, transactions coded in ICD-9 were not supposed to be processed and invoices/payments should have been rejected as noncompliant.  This is a required update according to HIPAA requirements so everyone in the health care industry was affected.

What self-funded plans should consider

As a self-funded plan you may want to take a look at your cash reserves in case there are delays in transactions, particularly as we approach fiscal year-ends for many companies.  Also be vigilant in looking for double-billing, which may occur if a diagnosis was made earlier in ICD-9 and then updated to ICD-10 after October 1.   You may also want to review your specific policies in medical eligibility for certain high-cost treatments or drugs as a change in coding may confuse or distort a previously clear position on such payments.

Clients of Stop Loss Insurance Brokers can feel assured that our claims management team has been well trained and is ready to prevent problems or fix errors that cross our desk on your behalf.

The Internet has a proverbial field day

The Internet is now full of ICD-10 code jokes.  You can imagine that with 68,000 codes in the code set (and potentially more coming), the diagnoses can get pretty specific.  Here are a few of our favorite memes created by a software company Intelicode.