It's not too early to begin preparing for the next version of the International Classification of Diseases – ICD-10. By now most providers are aware that the revised coding system, which takes effect Oct. 1, 2014, is substantially larger and more complex than the current ICD-9.
This was inevitable, given that the current codes are 30 years old and are too limited to reflect medical advancements, new technology, performance-based systems and other changes in health care.
In conjunction with the Centers for Medicare & Medicaid Services, Providence Health Plan and all major payers will convert to ICD-10 on Oct. 1. To make the transition as smooth as possible, it's important to plan ahead.
Practice management systems must be able to accommodate both ICD-9 and ICD-10 codes until all claims and transactions that occurred before Oct. 1 have been completed. Promptly processing ICD-9 transactions will help limit disruptions as the transition date nears, and it will help reduce the need for dual code sets.
All Providence Health Plan coding applications will be ready for formal testing by the summer of 2014. We will implement beta testing the first half of the year with select, yet-to-be-determined, providers and clearinghouse partners.
PHP is using general equivalency mappings, or GEMs, to map codes from one system to the other for all medical policies, payment policies, benefit applications, diagnostic edits and historical data tracking. PHP also will use “intent mapping,” in which the analyst compares ICD-9-CM codes to the expanded ICD-10-CM list to identify equivalent groupings. This way, PHP captures the intent of each code rather than simply creating a one-to-one crosswalk.
For providers, payment will continue to be based on Current Procedural Terminology (CPT) codes. You should not experience any change in payment due to ICD-10. For inpatient hospital-procedure billing, however, Diagnosis Related Group (DRG) codes may shift. We encourage your practice to conduct internal analytics to prepare for these changes.
Claims that do not use ICD-10 diagnosis and inpatient procedure codes on or after Oct. 1 cannot be processed. It's important to note, however, that claims for services provided before Oct. 1 must use ICD-9 diagnosis and inpatient procedure codes.
Legally, Providence Health Plan may not offer training on the ICD-10 transition to providers not employed by Providence. Training is available through CMS and other national entities. Providence Health Plan can identify why a claim was rejected, but we're unable to provide individual coding advice. To learn more about the process, read these FAQs.
Meanwhile The Centers for Medicare & Medicaid Services has more details on its ICD-10 website. To submit coding questions, visit the American Hospital Association's Coding Clinic Advisor.