The Transition To ICD-10 And Version 5010

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The Transition toICD-10 and Version 5010An OverviewNational Association of Rural Health Clinics TeleconferenceSeptember 30, 20101

Topics To Be Covered 2What exactly is changing?Why are the codes changing?Who is affected by the changes?Dates to knowICD-10: Key detailsVersion 5010: Key detailsResources to help you prepare

What Is Changing? Medical diagnosis and inpatient procedure codesets: ICD-9 ICD-10 HIPAA standards for electronic transactions:Version 4010/4010A Version 50103

Why are the Codes Changing? ICD-9 produces limited data about patients’medical conditions and hospital inpatientprocedures ICD-9 is 30 years old, has outdated terms, andis inconsistent with current medical practice The structure of ICD-9 limits the number of newcodes that can be created, and many ICD-9categories are full4

Who Is Affected?Anyone who is covered by HIPAA: Health care providers across continuum of carePayers including Medicaid and MedicareClearinghousesThird-party billing servicesSome non-HIPAA covered entities that use ICD-9codes:– Worker’s compensation programs– Life insurance companies5

Dates to Know January 1, 2011: Providers, payers, others whowork with electronic claims should begin externaltesting of Version 5010 January 1, 2012: Full implementation ofVersion 5010– All electronic claims must use Version 5010 standards October 1, 2013: Full implementation of ICD-10– All claims for services provided after these dates mustuse ICD-10 codes6

Now Is the Time to Prepare Version 5010 and ICD-10 transitions requirebusiness and systems changes throughout healthcare industry Organizations need to have plans and budgets inplace to avoid potentially rejected claims anddelays in reimbursement7

More on ICD-10 ICD-10 CM/PCS consists of two parts:– ICD-10-CM for diagnosis coding in all health caresettings– ICD-10-PCS for inpatient procedure coding inhospital settings CPT coding for outpatient procedures is notaffected by the ICD-10 transition8

More on ICD-10ICD-10-CM replaces ICD-9-CM for diagnosiscoding: ICD-9-CM diagnosis codes 3 to 5 digits ICD-10-CM codes 3 to 7 digits Overall format of ICD-10 diagnosis codessimilar to ICD-99

More on ICD-10ICD-10-PCS replaces ICD-9-CM inpatientprocedure coding: ICD-9-CM procedure codes 3 to 4 numericdigits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantiallydifferent from ICD-9 Unlike ICD-9, ICD-10 expands details formany conditions10

More on ICD-10 Provides more specific data than ICD-9 Better reflects current medical practice Structure accommodates addition of new codes11

More on Version 5010 Refers to new HIPAA standards for electronichealth care transactions Replaces Version 4010/4010A1 standards Accommodates ICD-10 code sets12

More on Version 5010Implementation Timeline Allows for a year of external testing:– January 1 to December 31, 2011– CMS begins accepting Version 5010 claims on January1, 2011, and continues to accept Version 4010 claims aswell through December 31, 2011 Occurs in advance of ICD-10 transition to ensureany Version 5010 issues resolved before ICD-10implementation13

When Do I Need to Be Ready?Remember the DatesJanuary 1, 2011January 1, 2012October 1, 201314

How to Prepare The following are steps you can take to prepare:– Identify your current systems and work processes thatuse ICD-9 codes– Talk with your practice management system vendorabout accommodations for both Version 5010 andICD-10 codes– Discuss implementation plans with all yourclearinghouses, billing services, and payers to ensurea smooth transition– Talk with your payers about how ICD-10implementation might affect your contracts15

How to Prepare The following are steps you can take to prepare:– Assess staff training needs– Budget for time and costs related to ICD-10implementation, including expenses for systemchanges, resource materials, and training– Conduct test transactions using Version 5010/ICD10 codes with your payers and clearinghouses– Stay up-to-date on ICD-10 resources andinformation from CMS16

Resources to Help You Prepare CMS ICD-10 Web site: CMS ICD-10 CMS ICD10 Industry Email Updates.asp CMS Materials– The ICD-10 Transition: An Introduction– ICD-10 Basics for Medical Practices– Talking to Your Vendors about ICD-10: Tips for Medical Practices Professional, clinical, trade associations17

CMS ICD-10 Fact Sheets18

ICD-10 Listserv MessagesSign up scribe.html?code USCMS 60819


More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10

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