ICD-10 What you Need to Know
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Monday, November 03, 2014 09:21 PM

Q. When will I be required to use ICD-10-CM?

A. On October 1, 2015 all providers will be required to report ICD-10 diagnosis codes on all claims with service dates that occur on October 1st or later.

Q. Is the October 1, 2015 date flexible? Will I be able to report ICD-9-CM after that time?

A. The October 1, 2015 date is not flexible. All Health Insurance Portability and Accountability Act (HIPAA) covered entities MUST implement the new code set with dates of service that occur on or after October 1, 2015. The Department of Health and Human Services is not planning to delay this implementation date.

Q. Why the need for change?

A. Developers of ICD-10-CM/PCS believe that this coding system allows providers to report greater specificity and clinical information. This increased specificity will assist in public health surveillance and provide an increased ability to statistically measure health care services. ICD-10 also includes updated health care terminology and provides higher quality data for processing claims, making clinical decisions, designing payment systems and measuring care provided to patients.

Q. What is the difference between ICD-9 and ICD-10?

A. ICD-10 codes provide greater detail in describing diagnoses and procedures. There are substantially more ICD-10 codes than ICD-9-CM codes. ICD-10-CM codes are longer and are comprised of 3-7 alpha or numeric digits. The first digit is alpha, the second is numeric and the following digits are either alpha or numeric. None of the alpha digits are case sensitive. Because of the increased size of the code, system changes will need to be made to accommodate ICD-10- CM codes.

Q. If I’m a non-covered entity under HIPAA do I have to use ICD-10-CM?

A. After ICD-10-CM is implemented, ICD-9-CM will no longer be maintained by the World Health Organization. Because of this, even non-covered entities may find that it is best to begin using ICD-10-CM. The Centers for Medicare & Medicaid Services (CMS) are also going to work with non- covered entities to encourage their use of ICD-10. At this time, no decision has been made on whether or not ICD-10 will be required on HIPAA exempt providers; however it may be mandated state by state.

Q. What are General Equivalence Mappings (GEMs)? As a doctor of chiropractic, will I be able to use the GEMs that are developed?

A. GEMs are reference mappings, to help the user navigate the challenge of translating the meaning from one code set to the other. The GEMs are more complex than a simple one-to-one crosswalk. Just like translating between languages, translating between coding systems does not necessarily yield an exact match. You may not be able to capture the full meaning of the original code because of underlying differences in the structure of the ICD-10. It is important to understand that one must learn how to look up a code under ICD-10 and not look for shortcuts which could lead to incorrect code choices. The use of GEMs is not provider specific.

Q. I am afraid that ICD-10-CM, with its large number of codes, is going to be confusing to implement in my office. Is ICD-10-CM difficult to navigate?

A. Many believe that ICD-10-CM is more logically structured and is therefore much easier to use than ICD-9-CM. ICD-10-CM is also currently being used by many doctors around the world without issue. As with any new system, it will take time to adjust, but it is a necessary change. To help with the transition from ICD-9 to ICD-10, General Equivalence Mappings (GEMs) will be available to assist in translating data from ICD-9-CM to ICD-10. For more information on GEMs go to: http://www.cms.gov/Medicare/Coding/ICD10/downloads/GEMs-CrosswalksBasicFAQ.pdf

Q. I’ve heard there might be a code freeze for ICD codes. What is that?

A. Many vendors and organizations involved in coding requested that a code freeze on new ICD codes be implemented. Some were concerned that transitioning to a new version of ICD-10 coupled with the introduction of additional new diagnosis codes could be overwhelming for providers. A proposal was introduced which would allow for the last regular, annual updates to both ICD-9-CM and ICD-10 to be made on October 1, 2011. There would then only be limited ICD-9-CM & ICD-10 updates for new technologies and diseases between October 1, 2013 to October 1, 2015. On October 1, 2016, regular updates to ICD-10 will begin. For more information see: http://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNMattersArticles/downloads/SE1240.pdf

Q. Is it true that it won’t be possible to buy an ICD-10-CM book? Will the information only be available online?

A. ICD-10-CM information will be available in book format from a variety of sources. Check the ACA Store for updates on available manuals in early 2014.

Q. How long after the October 1, 2015 ICD-10 compliance date must I continue to report and/or process ICD-9 codes?

A. Each payer determines their late filing requirements for standard transactions and ICD-10 does not require a change to these requirements. These deadline requirements vary among plans. Contact your payer for the current information regarding late filing for claims.page2image27000page2image27160page2image27320page2image27480

Q. How will I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2015 to on or after 10/1/2015?

A. Many payers are planning to require claims with dates of service that span the October 1, 2015 implementation date to be split so that the services prior to 10/1/2015 will be billed separately and utilize ICD-9 codes; services on and after 10/1/2015 will then be billed separately and utilize ICD-10 codes. All clinics should check specific payer guidelines for processing claims for services that span the 10/1/2015 ICD-10 transition date.

What Doctors of Chiropractic Should be Doing Now

  • Clinics should begin evaluating all of the situations in which ICD-9 is currently used and develop a plan to transition to ICD-10. For example, clinical documentation, quality measures reporting, and any lists of frequently used diagnosis codes should be updated to ICD-10.

  • Any clearinghouses, billers and practice management companies should be contacted to determine whether they will be upgrading systems to accommodate ICD-10 and whether there will be any cost to the provider for upgrades. Providers should also
    obtain a timeline from these vendors to ensure that all updates will be made prior to October 1, 2015.

  • DCs should understand their staff will need to undergo training on ICD-10. In-depth training on ICD-10 should start 6-9 months before the implementation date.

  • ACA publications should be consistently monitored for any updates and resources pertaining to ICD-10. 

Source:  http://www.acatoday.org/ICD-10/documents/ICD10_WhatDoINeedToKnow.pdf

Check other ICD-10 Myths HERE