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5 Things to Know About ICD-10


New ICD-10 Deadline– October 1, 2015

HHS has announced the final rule that delays the ICD-10 compliance date from October 1, 2014 to October 1, 2015.

October 1, 2015 will be the official date that ICD-9 will be replaced by ICD-10. If you didn't know the reason for the switch from ICD-9 to ICD-10, it is simply this - it is out of room. Apparently, the ICD-9 code set is unable to expand for additional disease classification or newly identified diseases. ICD-10 will include a larger mix of numbers an letters to increase the number of diagnosis codes available.

As the health care industry implements this new system, it is clear that lots of changes will take place. The first being the implementation of HIPAA 5010 beginning January 1, 2012 that will replace version 4010 in order to accommodate the increase in size and complexity of the ICD-10 codes.

From now until the compliance date, providers need to know 5 things in order to become fully prepared for the conversion to ICD-10.

1. Implementation Date

According to the Centers for Medicare and Medicaid Services (CMS), the ICD-10 implementation date is set for October 1, 2015. Effective on this date, ICD-9 will no longer be accepted. In order to get your medical claims paid, all providers should be prepared by making the necessary upgrades and/or changes to software, systems, and procedures that will be affected by the implementation process.

One system that is required for use with ICD-10 and a necessary preparation is the upgrade to Version 5010 standards. All providers, hospitals and payers must convert from Version 4010 standards for electronic health transactions to Version 5010 for electronic claims by the January 1, 2012 deadline in order to get medical claims paid.

CMS announced recently that they will delay enforcing compliance to the new version until March 31, 2012.

2. Benefits of Converting

Based on several health care industry reports, ICD-10 promises many benefits in comparison to ICD-9.

  • More accurate payments
  • More precise, detailed diagnosis
  • Fewer denials due to lack of medical necessity
  • Fewer requests for medical records to support diagnosis
  • Decrease in claims adjudication time frame
  • Less chance of medical coding errors
  • Reduction in medical errors leads to improved patient safety

3. Major Differences Between ICD-9 and ICD-10

ICD-9 Diagnosis Codes

  • 3 to 5 digits
  • First digit is alpha or numeric
  • Digits 2 thru 5 are numeric
  • Limited space for adding new codes
  • Lacks detail
  • Includes approximately 17,000 codes

ICD-10 Diagnosis Codes

  • 3 to 7 digits
  • Digit 1 is alpha
  • Digit 2 is numeric
  • Digits 3 thru 7 are alpha or numeric
  • Flexibility allows the addition of new codes
  • Very specific
  • Includes nearly 160,000 codes

4. Education and Training

It is necessary to begin developing a training plan now to be ready for ICD-10. Any one that needs coding to perform their job duties should receive some form of training including:

  • Physicians
  • Coders
  • Billing staff
  • Clinical staff
  • Front office staff

There are many resources available to the medical office for providing the necessary training for ICD-10:

  • Online Learning
  • Workshops
  • Conferences
  • Webinars
  • Computer Software
  • Books

Education and training may include an overview of or in-depth information for:

  • Medical terminology review
  • General and specialty code set training
  • Anatomy and physiology training
  • ICD-9 to ICD-10 crosswalks
  • Documentation specificity
  • Health insurance policy changes

5. Impact on Everything

The changes due to the new ICD-10 implementation will have an impact on everything within the medical office. When developing your implementation plan, keep these areas in mind:

  1. Front office staff
    • Changes to superbill or encounter form
    • Changes to notice of privacy rights
    • New requirements for prior authorization or pre-certification for medical procedures and treatment
    • Changes to patient coverage and new ABN forms
  2. Clinical staff
    • New requirements regarding documentation for patient accounts
    • More detailed use of anatomy and medical terminology
  3. Billers and Coders
    • Updates to insurance payer billing guidelines, policies and procedures, including Medicare and Medicaid
    • Changes to billing software and systems
    • More detailed use of anatomy and medical terminology
  4. Physicians
    • New requirements regarding documentation for patient accounts
    • More detailed use of anatomy and medical terminology
    • New requirements for patient orders
Photo courtesy of Joy Hicks

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