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Preparing for ICD-10
Technical Overview
The U.S. healthcare industry is changing from ICD-9 to ICD-10 for medical diagnosis and inpatient procedure coding. The transition will take effect on Oct. 1, 2013. The shift to ICD-10 is a HIPAA requirement and all HIPAA-covered entities, including providers, must comply. Any services or discharges coded with ICD-9 on or after Oct. 1, 2013 will be rejected by the Centers for Medicare and Medicaid Services (CMS), resulting in unpaid claims.
The transition to ICD-10 is substantial, impacting every system, process and transaction containing or using a diagnosis or procedure code. Because the ICD-9 code set is over 30 years old, there is no room for expansion. It is considered outdated and produces incomplete, limited data.
ICD-10 will bring an eight-fold increase in diagnostic and procedure codes and greatly enhance code specificity. This will necessitate complete and consistent documentation to support these expanded codes and extensive revisions to forms, systems and processes.
HIPAA Version 5010
The current HIPAA Version 4010/4010A1 for electronic transaction standards does not accommodate ICD-10 codes. As a result, Version 5010 will become effective on Jan. 1, 2012. Electronic transactions that do not use Version 5010 on or after Jan. 1, 2012 will be considered noncompliant with HIPAA and will be rejected.
ICD-10 Benefits
Because ICD-10 is a better reflection of current medical terminology and treatment, the code set will improve the measurement of quality, safety and efficacy of care. With room to expand and easy updating, ICD-10 will enhance system flexibility. The initiative will also result in:
- Better reflection of current medical terminology and medical treatment
- Better matching of payments
- Meeting the HIPAA criteria for code set standards
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