ICD-10. It’s closer than it seems.

As seen in the Consultant Connection July 2013 Issue
Submitted by: Martha Somers, Administrator of Information Technologies
Information gathered from www.cms.gov/ICD10
 
The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The ICD-10 deadline is October 1, 2014. 
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts: 
  1. ICD-10-CM for diagnosis coding 
  2. ICD-10-PCS for inpatient procedure coding 
 
About ICD-10
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar. 
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding. 
The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. 
 
Who Needs to Transition 
ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The change to ICD-10 does not affect CPT coding for outpatient procedures.
Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10, which means: 
  • All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes. 
  • ICD-10 diagnosis codes must be used for all health care services provided in the U.S., and ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid. 
 
Transitioning to ICD-10 
It is important to prepare now for the ICD-10 transition. How will ICD-10 affect your people and processes? To find out, ask all staff members how/where they use/see ICD-9. 
If you haven’t done so already, develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts.  
 
Keep Up to Date on ICD-10 
Visit the CMS ICD-10 website www.cms.gov/ICD10 for the latest news and resources developed by CMS to help you prepare for the October 1, 2014, deadline. 

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