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?