ICD-10/5010 Implementation: Are You Ready?

The following article is written by Michael Orseno, revenue cycle director for Regent Surgical Health.

 

ICD-10/5010 is rapidly approaching — is your facility ready? With less than six months to go before the first mandated phase of ICD-10, facilities need to take action to make sure they’re in compliance with CMS standards.

 

ICD-10 was implemented in 1993 by the World Health Organization to replace ICD-9, which was developed by WHO in the 1970’s. Several countries have already implemented ICD-10 including Australia and New Zealand. The Centers for Medicare and Medicaid Services (CMS) mandated an ICD-10 implementation date of 10/1/2013. All providers must use this diagnostic coding system at this time, otherwise claims will be rejected.

There are several differences between ICD-9 and ICD-10, mainly the specificity of the diagnosis as illustrated in the tables below:

 

Issue ICD-9-CM ICD-10-CM Volume of Codes Approximately 13,600 Approximately 69,000 Composition of Codes Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four, or five digits All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits Duplication of Code Sets Currently only ICD-9-CM codes are required. No mapping necessary For a period of up to two years, systems will need to access both ICD-9-CM and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies

The table below illustrates examples of the generality of ICD-9 vs. the specificity of ICD-10:

 

ICD-9-CM	ICD-10-CM
157 - Malignant neoplasm of pancreas	S52 - Fracture of forearm
157.0 - Head of pancreas	S52.5 - Fracture of lower end of radius
157.1 - Body of pancreas	S52.521 - Torus fracture of lower end of right radius
157.2 - Tail of pancreas	S52.521A - Torus fracture of lower end of right radius, initial encounter for closed fracture

 

Coders obviously will be heavily impacted — they will have to pass an online ICD-10 proficiency exam. Coders will have two years and a maximum of two attempts to take and pass the exam, which started in 10/2010 and will end on 9/20/2014.

Working in conjunction with ICD-10 is the implementation of X12 Version 5010. Often referred to simply as 5010, it is a prerequisite for ICD-10 which defines the rules for electronic data transmission of healthcare data. The new 5010 standard will replace the current 4010A1, which is not sufficient to handle the complex new code set of ICD-10. This will affect all electronic commerce including claims, remittance and eligibility.

CMS has mandated an implementation date of 1/12/2012 for all HIPAA covered entities. After the implementation, all covered entities are required to submit and receive compliant 5010 transactions including 837I (claims), 270/271 (eligibility), and 835 (remittance). Although this new format allows claims to be submitted with the new ICD-10 code set, facilities should continue to submit ICD-9 codes on all claims until 10/1/2013.

Systems that submit claims, receive remittances, exchange claim status and/or eligibility inquiries are all impacted by the 5010/ICD-10 conversion. These systems include SourceMedical’s AdvantX and Vision products, HST Pathways, Provation, ZirMed and Netwerkes. HST, Provation and ZirMed are already 5010 compliant, so facilities can begin testing immediately. SourceMedical is in the process of testing, so a 5010 compliance release should be forthcoming shortly.

With 5010 implementation less than six months away, facilities should begin testing immediately.

Learn more about Regent Surgical Health.

 

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