According to Centers for Medicare & Medicaid Services:
“ICD-10 allows us to speak the same language as the people that are going to be telling our story – for outcomes, for data assessment, and for billing. It’s incredibly important to have the severity of disease we are managing accurately portrayed.” Mark Bieniarz, MD Cardiologist
What this means to YOU:
Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10, which means:
All electronic transactions must use Version 5010 standards, required since January 1, 2012.
Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
ICD-10 diagnosis codes must be used for all health care services provided in the United States. ICD-10 procedure codes must be used for all hospital inpatient procedures.
Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid.
Transitioning to ICD-10
Steps you can take to get started with the transition to ICD-10 include:
Providers – Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts.
- Confirm with your vendor that your system has been upgraded to Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
- Contact your vendor and ask what updates they are planning to make to your practice management system for ICD-10, and when they expect to have it ready to install.
- Check your contract to see if upgrades are included as part of your agreement.
- Discuss with your vendor what customer support and training that they will provide.
- Discuss with your vendor how their products and services will accommodate both ICD-9 and ICD-10 as you work with claims for services provided both before and after the transition deadline for code sets.
- If you are in the process of making a practice management or related system purchase, ask if it is ICD-10 ready.
- Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.
Implementing ICD-10 vs. waiting for ICD-11:
The history of updating the ICD system in the United States indicates that skipping directly to ICD-11 implementation could take too long. The World Health Organization published ICD-9 in 1978 and endorsed ICD-10 in 1990. The first draft of ICD-10-CM was released in 1995, but HHS did not propose the rule for ICD-10 adoption until 2008. The WHO is not slated to release ICD-11 until 2017. Based on the historical timelines of implementation, it will be 2039 until the United States is fully transitioned to ICD-11-CM. It is also important to note that the gap between ICD-9 and ICD-10 is not nearly as large as the gap between ICD-9 and ICD-11. At this point in time, a transition directly to ICD-11 would be an even larger and more dramatic undertaking for the US healthcare industry.
The change to ICD-10 does not affect CPT coding for outpatient procedures.
The following features fact sheets, FAQs, and implementation guides, timelines, and checklists:
How To Improve Quality Scores
- Review diabetes services at each visit for patients with a diabetes diagnosis
- Order labs prior to patient appointments so that they can be reviewed at the appointment
- If point of care services are done in the office (ex: HbA1c), make sure that the code is on the claim
- HbA1c codes: 83036; 83037
3044F – HbA1c less than 7.0%
3046F – HbA1c greater than 9%
** The date of service reported for CPT II codes 3044F & 3046F and the date of service of the test result must be no more than seven days apart
- Monitor HbA1c and BP levels and adjust treatment as needed. Follow up with patients to monitor progress
- Make sure that patients with a diabetes diagnosis have a retinal or dilated exam each year. Digital eye exams, remote imaging and fundus photography must be read by an eye care professional (optometrist or ophthalmologist)
- Remember to add code 3072F to the claim if the member’s retinal or dilated eye exam was negative or showed no evidence of retinopathy in the prior measurement year
YourCare CDC Code Tip Sheet: