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Transitioning to ICD-10

International Classification of Diseases, Tenth Revision (ICD-10) is part of a government mandate. In January 2009, the Department of Health and Human Services (HHS) published the final rule, with an ICD-10 compliance date of October 1, 2014.

ICD-10 represents a major revision to ICD-9 diagnosis and procedure coding. Changes will include use of alpha numeric codes, restructured categories, a revised coding scheme and significantly expanded detail of procedure/diagnosis codes. ICD-10 is anticipated to have over 800 more code categories than ICD-9.

Provider Implementation

The way you code your claims will change from ICD-9 (International Classification of Diseases, 9th Revision) to ICD-10 (International Classification of Diseases, 10th Revision). The transition will require business and systems changes throughout the health care industry. All providers covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition (this is not limited to just Medicare or Medicaid providers). It is important that you start planning now to make this transition to ICD-10.

A pre-requisite to ICD-10 is upgrading electronic health transactions from Version 4010 to 5010. You should already be working on this upgrade to Version 5010 which must be finished by January 1, 2012.

The compliance dates set by the U.S. Department of Health and Human Services (HHS) are firm. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues. For more information, please visit the American Medical Association.

Vendor Implementation

Software vendors, clearinghouses and third-party billing services should develop products and services that will allow payers and providers to fully implement ICD-10 (International Classification of Diseases, 10th Revision) on October 1, 2014. Products and services will be obsolete if steps are not taken now to get ready. Start talking with your customers now about preparing for the ICD-10 transition.

Also, speak to customers now about preparing for Version 5010. It is important that your customers have products and services available for Version 5010 testing by January 1, 2011, and full implementation by the January 1, 2012, compliance deadline. Products and services that are not Version 5010-compliant could become obsolete.

Customers will look to you to support their transition with new and upgraded products, available well in advance of the deadlines to allow adequate testing. Now is the time to talk to your customers about your plans to ensure that their Version 5010 and ICD-10 transition goes smoothly and on schedule. Your customers need to know that:

  • They can count on your products being compliant and fully functional.
  • They will not have to worry about potential reimbursement issues.

Ask customers about their needs and establish a comprehensive approach that will deliver compatible products well ahead of the transition deadlines. Talking to your customers now about ICD-10 and Version 5010 will put you ahead of the curve and help you maintain strong business relationships.

Consider discussing the following:

  • Systems upgrades/replacements needed to accommodate Version 5010/ICD-10
  • Costs involved and if upgrades will be covered by existing funding
  • When upgrades or new systems will be available for testing and implementation
  • Customer support and training that you will provide
  • How your products will accommodate both ICD-9 and ICD-10 as your customers work with claims for services provided both before and after the transition deadline for code sets.