Tuesday, April 23, 2013

ICD-10 Transition Basics

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. 

1. What does ICD-10 compliance mean?
ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes.

2. Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding? 
No. The switch to ICD-10 does not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.

3. Who is affected by the transition to ICD-10? If I don’t deal with Medicare claims, will I have to transition?
Everyone covered by HIPAA must transition to ICD-10. This includes providers and payers who do not accept Medicare. 

4. Do state Medicaid programs need to transition to ICD-10?
Yes. Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10. 

5. What happens if I don’t switch to ICD-10?
Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes.

6. If I transition early to ICD-10, will CMS be able to process my claims?
No. CMS and other payers will not be able to process claims using ICD-10 until the compliance date. However, providers should expect ICD-10 testing to take up to 19 months. 

7. Codes change every year, so why is the transition to ICD-10 any different from the annual code changes?
ICD-10 codes are different from ICD-9 codes and have a completely different structure. Currently, ICD-9 codes are mostly numeric and have 3 to 5 digits. ICD-10 codes are alphanumeric and contain 3 to 7 characters. ICD-10 is more robust and descriptive with “one-to-many” matches in some instances.

Like ICD-9 codes, ICD-10 codes will be updated every year.

What strategies have you developed to successfully transition your company to ICD-10? 
Have you completed Documentation Improvement Initiatives? Have you mapped your 50 most commonly billed codes to ICD-10? Are you tracking and monitoring your progress through internal compliance reviews?  How will you protect your revenue while managing the costs of transition?

If not, you must start now. The deadline is fast approaching!
Call ERM today for a free consultation 877-938-9232

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