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ICD-10 Prepared

The healthcare industry is preparing for monumental changes as it transitions toward implementing the International Classification of Diseases, Tenth Revision, also known as ICD-10 and the HIPAA 5010 transaction standard to support electronic transactions. In general the intent is to provide better data for measuring healthcare service quality, safety and the efficacy of care.

How Does ICD-10 Conversion Affect Me?

As a result of coding and transaction standard changes, physicians and healthcare executives will need to address several business issues in order to adhere to new coding compliance changes and minimize any potential disruption of care services.

Business Issues

• Existing practice management billing system software may need to be replaced or updated to accommodate 5010 electronic transactions standards
• Clinical and administrative staff will need training on new code sets and changes to technology
• Current practice work flow will need to be modified to accommodate new information technology
• Vendor, clearinghouse, and health plan contracts and data requirements will need to be reviewed and amended, or replaced
• Super bills and corresponding mapping strategies will need to be updated
• The quality and accuracy of clinical documentation practices must be improved to maintain compliant claims
• Billing forms must be revised or replaced

Quick Reference

5010/D.O	ICD-10-CM/PCS
*Centers for Medicaid and Medicare, CMS.gov/ICD-10 http://www.cms.gov/ICD10/
Summary New standardized formats Must be completed prior to ICD-10	Summary New standard for medical diagnosis and procedure codes Dependent on 5010 Upgrade
*Compliance Date January 1, 2012	*Compliance Date October 1, 2013
*Format Changes Increase field size from 5 to 7 bytes Adds a one-digit version indicator to indicate version 9 vs. 10 Increases # of diagnosis codes allowed on a claim Enhanced data elements & other data modifications adopted by Medicare	*Format Changes ICD-9-CM ICD-10CM ICD-9-CM ICD-10-PCS Increases field size from 5 to 7 bytes Increased clinical categories and diagnosis & procedural specificity
Requirements Required for submission of ICD-9 and ICD-10 codes Enhanced electronic transmission of claims	Requirements Additional specificity will require expanded knowledge of Anatomy & Physiology Clinical documentation will be cornerstone to accurate coding