U.S. health care organizations are moving from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The codes are used to report medical diagnoses and inpatient procedures for payments. On April 1, 2014, President Obama signed into law a bill that delays ICD-10 implementation to begin no sooner than October 1, 2015.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note that the change to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures and physician services.
Please send any inquiries regarding ICD-10 to ProviderServices@hpsj.com
These FAQs provide an overview of the transition to ICD-10 and points to resources for more information.
If you have any questions regarding billing with ICD-10 codes, please refer to the Medi-Cal website at: http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaa_icd10_home.asp.
For providers who have not yet started to transition to ICD-10, below are action steps to take now. Some of these activities, such as establishing a transition team and communicating to internal staff, might not be necessary for small practices where one or two people would be handling the transition activities.
- Establish a transition team or ICD-10 project coordinator, depending on the size of your organization, to lead the transition to ICD-10 for your organization.
- Develop a plan for making the transition to ICD-10; include a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, resources needed, and estimated start and end dates.
- Determine how ICD-10 will affect your organization. Start by reviewing how and where you currently use ICD-9 codes. Make sure you have accounted for the use of ICD-9 in authorizations/pre-certifications, physician orders, medical records, superbills/encounter forms, practice management and billing systems, and coding manuals.
- Review how ICD-10 will affect clinical documentation requirements and electronic health record (EHR) templates.
- Communicate the plan, timeline, and new system changes and processes to your organization, and ensure that leadership and staff understand the extent of the effort the ICD-10 transition requires.
- Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, revision of forms, workload changes during and after implementation, and risk mitigation.
- Talk with your payers, billing and IT staff, and practice management system and/or EHR vendors about their preparations and readiness.
- Coordinate your ICD-10 transition plans among your trading partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
- Talk to your trading partners about testing, and create a testing plan.
Should you have any questions regarding ICD-10, please contact us at ProviderServices@hpsj.com.
Posted on June 17th, 2015 and last modified on October 2nd, 2015.