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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, 2013.  Since then, the compliance date has been delayed twice, to October 1, 2014, and, most recently, to no earlier than October 1, 2015.  The new implementation date  is to be announced by HHS. Visit the  CMS.gov webpage for the latest updates.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 you continue your planning, training and testing to make a successful transition to ICD-10.  In your transition planning that should remain underway,

  • Take the opportunity to fully test systems and processes
  • Refocus work during the transition
  • Incorporate lessons learned from the previous delays
  • Expand collaboration with other organizations, vendors, and payers
  • Extend and specify training.

If you are not ready to use ICD-10 on the compliance date, your claims will not be paid.  Preparing now can help you avoid potential reimbursement issues.  For more information, please visit the CMS.gov Provider Resources page.

Vendor Implementation

Software vendors, clearinghouses and third-party billing services have developed products and services that allow payers and providers to fully implement ICD-10  on the compliance date.  Certain 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.  If you have begun discussions, ensure that you have a clear understanding of customer requirements.

Customers look to you to support their transition with new and upgraded products, available in advance of the new deadline.   Take advantage of this delay to conduct robust testing in support of a smooth transition to ICD-10.  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.

Consider discussing the following:

  • Systems upgrades/replacements needed to accommodate 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 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.

Blue Cross Blue Shield Plans

Many Blue Plans launched their ICD-10 transition projects in late 2008 when the final rule  was published.  All Blue Plans have been working steadily since then to ensure they are ready to receive and use ICD-10 codes  on claims received starting on the HHS  compliance date. The Blues are committed to making the transition to ICD-10 successful across all health care delivery system with all stakeholders.