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Look for ICD-10 sessions that go beyond the basics

You might be far enough along in your ICD-10 implementation timeline to attend some informational sessions that go beyond the basics. “You’re going to see more companies advertising functional learning as opposed to theoretical sessions,” says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, director of coding and HIM at HCPro, Inc., in Marblehead, MA.

Just to provide some examples, I’ll highlight two that I recently came across:

• The Workgroup for Electronic Data Interchange (WEDI) will host a conference July 28-30 in Fairfax, VA, titled, “Advancing Along the Implementation Highway: The Road Map to Success” covering implementation of the HIPAA 5010 transaction sets and the ICD-10 code sets.

“This will not be a 101-level session on the 5010 transactions or the differences between ICD-9 and ICD-10,” according to WEDI. “Instead, come prepared to discuss and develop ‘working solutions’ to business impacts in sessions that invite your input.”

HIPAA 5010 sessions will cover a range of topics, including:

1. Transactions/implementation issues
2. How to influence senior executives to make 5010 a priority now
3. What Level I compliance means
4. Medicare EDI front-end changes
5. Development of test scenarios

ICD-10 sessions will cover a range of topics, including:

1. Crosswalks
2. Testing
3. The impact assessment process
4. Project team formation and structure
5. Clinical considerations

• The Massachusetts Health Data Consortium is hosting an information session in Waltham, MA, on June 23 titled, “Preparing for ICD-10 Implementation, ” during which two CMS regional representatives will offer their thoughts on how ICD-10 will affect Massachusetts healthcare organizations. What are the implications of ICD-10 for your organization? How will it affect patient care, office efficiency, and healthcare organization revenue?

Look for similar sessions in your area. Check with local, regional, and national associations.

The 411 on HIPAA version 5010

One of the many things that will be affected in order to accommodate the ICD-10 codes is the format of electronic claims. CMS recently announced that it receives more than 99% of the Medicare Part A claims and more than 95% of the Part B claims electronically. Today, physicians submit electronic claims to Medicare using Accredited Standards Committee (ASC) X12N Version 4010/4010A1. Because the existing format lacks functionality for certain transactions (e.g., the ICD-10 reporting system), Version 5010/D.0 will eventually replace the current electronic claims version. 

Electronic communication between physicians and payers and hospitals requires that we have standardized codes to enable the electronic exchange of certain health information.

Standards exist today for eight electronic transactions and six code sets. The transactions are:
• Health Care Claims or Equivalent Encounter Information
• Eligibility for a Health Plan
• Referral Certification and Authorization
• Health Care Claim Status
• Enrollment and Disenrollment in a Health Plan
• Health Care Payment and Remittance Advice
• Health Plan Premium Payments
• Coordination of Benefits

The code sets are:
• International Classification of Diseases, 9th Edition, Clinical Modification, Volumes 1 and 2
• International Classification of Diseases, 9th Edition, Clinical Modification, Volume 3 Procedures
• National Drug Codes
• Codes on Dental Procedures and Nomenclature
• Health Care Common Procedure Coding System
• Current Procedural Terminology, 4th Edition

The ICD-9 code sets, developed nearly 30 years ago, contain approximately 17,000 codes and can no longer be adequately expanded. The ICD-10 code sets have more than 155,000 codes to accommodate advances in diagnoses and procedures. The ICD-10 and transaction rules have long been expected and must move together, as Version 5010 was designed to be used with the ICD-10 code sets. While Medicare contractors will be ready to handle the new standards and the HIPAA 5010 claim format by January 1, 2011, the compliance date for submitting claims in the new format is not required until January 1, 2012. CMS recently released a Special Edition MedLearn Matters article SE0904 that provides a high-level overview of some of the differences between the two claim formats, with additional resources.

CMS seeks feedback from the industry on a potential code freeze

On May 19, CMS hosted a conference call during which it addressed the use of General Equivalence Mappings (GEMs). A transcript of the call is now available on the CMS Web site.

CMS representative Pat Brooks, RHIA, senior technical advisor for the hospital and ambulatory policy group highlighted an important agenda item that will be discussed at the September 16-17 ICD-9-CM Coordination and Maintenance meeting.

Many in the industry have expressed to CMS that they feel it is important for CMS and Centers for Disease Control and Prevention to consider freezing updates to the ICD-9-CM and ICD-10 coding systems prior to the October 1, 2013 implementation. Many have said that freezing the codes would make it easier to develop educational materials for the implementation without worrying about updating them each year. Many people also said that they felt this kind of freeze would help vendors develop products.

In the ICD-10 final rule, CMS said that it would take this issue to the ICD-9 Coordination and Maintenance Committee and seek input from various providers and vendors and others on what they thought about this suggestion. CMS will pose the following questions at that September 16-17 meeting:

• Should there be a freeze?
• If so, should it be of both ICD-9 and ICD-10 or one or the other? 
• When should the freeze begin? For example, should October 1, 2012 be the last time ICD-9-CM codes and ICD-10-CM and PCS codes are updated? Or should a freeze be established as early as 2011? 

“These are the kinds of things we need to know from the industry,” Brooks said during the call. “We’ll be actively soliciting input from you to speak about whether there should be a freeze, and if so, when should the freeze be? Come to the meeting and discuss this.”

You can register for this meeting beginning August 14. Or write to CMS after the meeting, and provide your own input. Be sure to answer the following questions:

• How important would this freeze be to your organization? 
• Should ICD-9-CM and/or ICD-10 be frozen prior to ICD-10 implementation?
• When should the freeze begin?

The switch to ICD-10 doesn’t have to be painful – does it?

Over the last couple months, I have tried to get a sense of how far along people are in the ICD-10 planning process. The verdict? While it’s definitely on the radar, it seems as though most have not actually taken any action toward forming an ICD-10 team or forming an implementation timeline. Something tells me that the mere thought of all the aches and pains that come with this change makes people shudder and look the other way. Of course, there are so many other reasons that might be a factor in putting off planning for the new coding system. Are you in the middle of implementing an electronic health record system? Are you up to your ears in physician queries and documentation improvement initiatives? What has kept ICD-10 on the back burner at your practice or facility?

Don’t neglect January 1, 2012 deadline for 5010 implementation

Even before you implement ICD-10 in 2013, you will need to make sure that the 5010 electronic code sets are in place at your facility. You must implement the 5010 code set by January 1, 2012. As an extension of your ICD-10 implementation team, consider organizing a subcommittee to address the 5010 transaction code sets.

News Alert: ICD-10 will go live October 1, 2013

The date’s official: October 1, 2013! On January 15, the Department of Health and Human Services (HHS) released the long-awaited ICD-10 final rule, which sets implementation for two years later than what HHS originally proposed.

But please don’t think this gives you time to put ICD-10 on the back burner. While their strategies and tips might differ, all the experts agree on one thing: Start planning for ICD-10 now.

“The extra time should be used wisely and the industry needs to start now and not wait,” said Linda L. Kloss, CEO for the American Health Information Management Association (AHIMA) in an AHIMA press release

To access HCPro’s e-blast covering this breaking news, click here.

To access the ICD-10 final rule, click here.

To view a fact sheet describing both rules, click here.

To view the press release, click here.