The U.S. Department of Health and Human Services (HHS) has issued a final rule to move from the currently used International Classification of Diseases (ICD-9) to the next generation of ICD-10 code sets by Oct. 1, 2014. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. ICD-9 has just over 14,000 diagnosis codes and almost 4,000 procedural codes. In contrast, ICD-10 contains over 68,000 diagnosis codes (clinical modification codes) and over 72,000 procedural codes.
What is ICD-10?
There are two categories:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD- 9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
What are the benefits of ICD-10?
The transition to ICD-10 is occurring because ICD-9 produces limited data about patients' medical conditions and hospital inpatient procedures.
- Greater level of specificity and clinical detail
- Improvements will better capture advances in medical technology
- Medical terminology and classification of diseases have been updated to be consistent with current clinical practices
- Up-to-date classification systems will provide much better data for measuring the quality, safety and efficacy of care; designing payment systems and processing claims for reimbursement; and setting health policy
The effective date is October 1, 2014.
What should I be doing today?
The Centers for Medicare and Medicaid Services and HHS have stated there will not be an extension or contingency period for ICD-10. The Oct. 1, 2014 compliance date is not flexible. Claims submitted with non-compliant codes on or after Oct. 1, 2014 will be rejected.
This mandate will impact your business. The business challenge is to understand where and how ICD-9 codes are currently used in an organization. Reach out to your trading partners about ICD-10 to determine their readiness. However, do not rely on vendor solutions without looking at your processes to understand the full impact of the ICD-10 transition.
Identify your training needs:
- All physicians, nurses, and other employees will need to become familiar with the new codes
- Physicians, billers, coders and office staff should refresh their knowledge of medical terminology
- Coders will need ICD-10 certification training; completion is recommended six to nine months before compliance date
- Have a plan in place to cover your daily operations as staff members attend trainings
Will BCBSND help?
BCBSND will work collaboratively with medical societies, associations and other external entities to assist with compliance efforts.