The department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets medical coders and billers in the United States use now to report healthcare diagnoses and procedures with ICD-10 code sets, effective October 1, 2013. Incorporation of ICD-10 codes is the biggest change in standard healthcare coding systems in decades which will not only drastically increase but also change the structure of the codes that providers and payers have been using for the past three decades. Before that, on January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. This change before the ICD-10 implementation date helps in adequate testing and implementation time. Along with its transaction precursor Version 5010, ICD-10 implementation will impact every system, process and transaction that contains or uses a diagnosis code.
No wonder, this is often but correctly compared to the effort and planning that took place around Y2K.
- Incorporates much greater specificity and clinical information, which results in:
- Improved ability to measure health care services
- Increased sensitivity when refining grouping and reimbursement methodologies
- Enhanced ability to conduct public health surveillance
- Decreased need to include supporting documentation with claims
- Includes updated medical terminology and classification of diseases
- Provides codes to allow comparison of mortality and morbidity data
- Provides better data for payers, providers, federal agencies:
- Measuring care furnished to patients
- Designing payment systems
- Processing claims
- Making clinical decisions
- Tracking public health
- Identifying fraud and abuse
- Conducting research
- Identify your current systems and work processes that use ICD-9 codes
- Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes
- Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition
- Talk with your payers about how ICD-10 implementation might affect your contracts
- Identify potential changes to work flow and business processes
- Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes
- Budget for time and costs related to ICD-10 implementation
- Conduct test transactions using Version 5010/ICD-10 codes with your payers and clearinghouses
- Factor in any abnormal cash flow disparity post implementation from a contingent situation
- Incorporate a team to handle ICD-10 implementation
- Start an intranet resource for ICD-10 implementation team to share/update information
- Assess and identify processes/systems using ICD-9-CM
- Allocate adequate financial and human resources for smooth transition to ICD-10
- Provision a system to look up archived ICD-9-CM data post ICD-10 implementation
- Assess staff training needs and provide them with adequate online training, as to minimize their absence from work while at training
- Prepare for implement of Version 5010, the transaction precursor of ICD-10
- Review vendor readiness and assess their game plans for smooth ICD-10 implementation
- Conduct adequate test transactions using Version 5010/ICD-10 codes
- Start a team of core staff with goal of successful migration of all clients to ICD-10 implementation
- Assess client requirements and SOPs at various levels
- Provide emphasis to hire/train adequate human IT resources
- Identify/train human IT resources to include general equivalency mappers (GEMs) offered by CMS to discern the divergence between ICD-9 and ICD-10 and use the reimbursement mapping
- Engage clients to provide them regular updates, upgrades, any changed deadlines until smooth transition of each of your clients to ICD-10
Please click here to view the deadlines on official CMS website.





