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ICD-10

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

Provider FAQs

These FAQs provide an overview of the transition to ICD-10 and points to resources for more information.

What if the claim submitted has an incorrect code?
A clean claim should be submitted. Do not submit a provider dispute or a corrected claim.
What if my practice needs the correct code?
Government regulations do not allow HPSJ to correct coding errors or provide specific codes. 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.
When is the ICD-10 compliance deadline?
The ICD-10 deadline is October 1, 2015.
What does ICD-10 compliance mean?
ICD-10 compliance means that a HIPAA-covered entity uses ICD-10 codes for health care services provided on or after October 1, 2015. ICD-9 diagnosis and inpatient procedure codes cannot be used for services provided on or after this date. Everyone covered by HIPAA must be ICD-10 compliant starting on October 1, 2015.
Who is affected by the transition to ICD-10? If I don’t deal with Medicare claims, will I have to transition?
Everyone covered by HIPAA must use ICD-10 starting October 1, 2015. This includes health care providers and payers who do not deal with Medicare claims. Organizations that are not covered by HIPAA, but use ICD-9 codes should be aware that their coding may become obsolete if they do not transition to ICD-10.
Do state Medicaid programs need to transition to ICD-10?
Yes. Like everyone else covered by HIPAA, state Medicaid programs must use ICD-10 for services provided on or after October 1, 2015. Like ICD-9 codes, ICD-10 codes will be updated every year.
What happens if I don’t switch to ICD-10?
ICD-9 codes will not be accepted for services rendered on or after October 1, 2015. Claims for all services and hospital inpatient procedures performed on or after October 1, 2015, must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes.
Will I need to use both ICD-9 and ICD-10 codes during the transition?
Practice management systems must be able to accommodate both ICD-9 and ICD-10 codes until all claims and other transactions for services before October 1, 2015, have been processed and completed. Promptly processing ICD-9 transactions as the transition date nears will help limit disruptions and will limit the timeframe when dual code sets need to be used.
If I transition early to ICD-10, will CMS be able to process my claims?
No. CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2015, compliance date. However, organizations will need to work with their internal team and with business trading partners to test their software systems from beginning to end. This involves testing claims, eligibility verification, quality reporting and other transactions and processes using ICD-10 to make sure the new code set can be processed correctly.
What should providers do to prepare for the transition to ICD-10?
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.
Who do I contact for more information about ICD-10?
Should you have any questions regarding ICD-10, please contact us at ProviderServices@hpsj.com.