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Make it easy on yourself; let us help you discover ICD-10-CM
e-Reports, October 25, 2010
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Cramming might have worked in college or med school; it doesn’t bring success in the real world. So, while a deadline of 2013 for ICD-10 seems far away, it’s set in the future so you can do proper preparation and training. The best advice from experts: Make use of this time because the deadline will not be moved.

You should be preparing for HIPAA version 5010; use ISMA, AMA resources

The Jan. 1, 2012, compliance date for sending and receiving only the version 5010 transactions is a little over a year away. Missing this deadline puts you at risk for rejected transactions, denied claims and delayed reimbursement.

You have plenty to do to prepare. External testing with your trading partners is critical for ensuring that you are set to go.

The Centers for Medicare & Medicaid Services' (CMS) Medicare Fee-for-Service program will be ready to test the version 5010 transactions in January 2011. CMS has made it clear the Jan. 1, 2012, deadline for implementing the version 5010 transactions will not be extended.

ISMA Reports suggested a step-by-step process in the Sept. 7 issue.The AMA has resources to help you prepare to implement HIPAA version 5010. 

Why retire ICD-9?
The problem was space. The 30-year-old International Classification of Diseases known to us as ICD-9 simply ran out of space for new codes, making it unable to accurately reflect advances in medical knowledge or technology. The changeover will impact all physicians in every specialty.

ICD-10, which other countries have used for a long time, has undergone “clinical modification” for use with inpatients in the U.S. Offering thousands of new diagnosis codes, ICD-10-CM has improved descriptions to greatly enhance code selection, though you will routinely use only a small section of the codes available.

How will ICD-10-CM work?
With ICD-9 you likely had one code to describe an encounter; ICD-10 may offer 150 or more codes to allow for greater clinical detail and specificity when communicating diagnoses and procedures.

The Centers for Medicare & Medicaid Services (CMS) already has a mapping system on its website to help you with the transition. Called “general equivalency mappings” or GEM, the system will help you convert an existing ICD-9 code to the new ICD-10 code and vice-versa.

The AAPC, which educates and credentials coders, also has a helpful conversion tool, the ICD-10 Code Translator, on its website.

Check them out and start practicing with codes you use frequently.

Consider that you’ll need to run both ICD-9 and ICD-10 together on your systems for a while to handle appeals and other things. You may need to turn each system off and on as needed to follow up on old claims or requests for payback.

While the compliance deadline for ICD-10 is Oct. 1, 2013, you have plenty to do before that date. Here are some suggested steps:

  • Conduct an impact analysis
  • Contact vendors, trading partners and payers
  • Install vendor upgrades
  • Conduct internal testing
  • Update internal processes
  • Do staff training
  • Conduct external testing with vendors
  • Do it: Convert to ICD-10-CM

Plan now to budget for implementation costs like systems changes, resource materials and training. Start asking your vendors if they will charge for the upgrades and when those upgrades will be available.

Also see the article below for details about a recently announced code freeze set to precede ICD-10 implementation.

Plenty of helpful resources already exist; ISMA Reports will pass along more in the coming months.

Check the ICD-10 page on the ISMA website.

To ease the transition:CMS announces code freeze

The ICD-9-CM Coordination and Maintenance Committee announced implementation of a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes on Oct. 1, 2013, prior to implementation of ICD-10. The partial freeze, which had considerable support, will be implemented as follows:

  • The last regular, annual updates to both ICD-9-CM and ICD-10 code sets will occur Oct. 1, 2011.
  • On Oct. 1, 2012, the committee will make only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases, as required by section 503(a) of Pub. L. 108-173.
  • On Oct. 1, 2013, the committee will make only limited updates to ICD-10 code sets to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. No updates will be made to ICD-9-CM, as it will no longer be used for reporting.

Regular updates to ICD-10 will begin Oct. 1, 2014.

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