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The International Classification of Diseases codes will undergo significant changes to address the limitations of coding hospital inpatient procedures and patient medical conditions. Here's what you'll need to know to stay abreast.
The International Classification of Diseases codes will undergo significant changes to address the limitations of coding hospital inpatient procedures and patient medical conditions. Here's what you'll need to know to stay abreast.
On October 1, 2013, significant changes to the International Classification of Diseases (ICD) codes will become effective. The current ICD-9 codes used to report inpatient procedures and diagnoses will be replaced by ICD-10 codes. To support this change transaction standards for electronic health care claims will be upgraded from Version 4010/4010A, to version 5010 by January 2012.
The transition to ICD-10 codes was primarily implemented to address the limitations with ICD-9 coding of hospital inpatient procedures and patient medical conditions. Most notably, ICD-9 coding contains outdated terms (30 years old) and is inconsistent with current medical practice. In addition, the ICD-9 categories have reached their intended capacity and therefore structurally limit the number of new codes that can be created.
The new ICD-10 consists of 2 parts:
1. ICD-10-PCS for inpatient procedure coding
For use in all inpatient US hospital settings. ICD-10 inpatient procedure codes utilize 7 alphanumeric digits instead of the 3 to 4 numeric digits used for ICD-9-CM coding. As a result, the ICD-10-PCS coding is more specific and substantially different from the ICD-9-CM coding.
2. ICD-10-CM for diagnosis coding
For use in all US health care settings, ICD-10 diagnosis cose utilize 3 to 7 digits instead of the 3 to 5 digits used for ICD-9-CM coding. The ICD-10-CM code set formats are similar to ICD-9-PCS coding.
WHO NEEDS TO TRANSITION?
The ICD-10 transition will not just affect those who submit Medicare or Medicaid claims, it will affect diagnosis and inpatient procedure coding for all covered entities governed by the Health Insurance Portability and Accountability Act (HIPAA).
Covered entities governed by HIPAA who transmit electronic claims must also abide by Version 5010 transaction standards. The change to ICD-10 does not affect CPT coding for outpatient procedures. Covered entities must be prepared to comply with the Version 5010 and ICD-10 transitions, which means:
TRANSITION PREPARATION
It is important that you prepare for the ICD-10 and Version 5010 transition as soon as possible. Here are some tasks to help you get started:
VERSION 5010 AND ICD-10 SOURCE INFORMATION
The Centers for Medicare & Medicaid Services (CMS) website is (www.cms.gov/ICD10) provides resources to help you prepare for Version 5010 and ICD-10. CMS will continue to add new tools and information to the site throughout the course of the transition, so be sure to check the site frequently for updated resources.
There are also several professional, clinical, and trade associations offering a wide variety of Version 5010 and ICD-10 educational resources, information, and checklists. Call or check websites of your associations and other industry groups to see what resources are available.
About the Authors
Quintin Jessee, PharmD, is director specialty pharmacy consulting for D2 Pharma Consulting LLC and has more than 10 years of senior management experience in specialty pharmacy operations.Jim Maguire is the chief executive officer of BioMed Intelligence, Inc, a firm specializing in health care information technology support solutions. With more than 20 years of experience, Mr. Maguire was formerly the chief information officer of a top pharmacy benefit manager and also led information technology operations at a top specialty pharmacy. Contact Mr. Maguire at (347)847-357; jmaguire@biomed-intelligence.com or www.biomed-intelligence.com.