On October 1, 2015, ICD-10, also known as the International Classification of Diseases – 10th Edition was initiated. Used to classify diseases and causes of illness recorded on health records, claims, and other vital information, ICD-10-PCS is the procedure classification system utilized to report hospital inpatient procedures. Here, we pulled together all the information you will need to be prepared for the new set of medical diagnosis and procedure codes coming this Fall.
Why Is It Happening?
The previous coding system, ICD-9 was 30 years old, producing limited data about patients’ medical conditions and hospital inpatient procedures, has inconsistency issues regarding current medical practices, as well as outdated terms. The transition into ICD-10 improves the quality of management within the health care system as it provides additional important information about a patient’s condition or the procedure performed.
Here’s what’s new:
- ICD-10 uses 3-7 digits, rather than the 3-5 digits used with ICD-9
- ICD-10 includes over 140,000 codes, compared to the current 18,000 codes in ICD-9
- ICD-10-PCS codes are constructed through the assignment of characters, each representing an aspect of the inpatient procedure.
- The detailed coding logic and format are used to identify symptoms, conditions, complaints noted, and more
How It Affects Us
Everyone who is covered by HIPAA (Health Insurance Portability and Accountability Act of 1996) is affected by the transition of ICD-10. Health plans, providers, vendors, billers, administrators, software vendors, clearinghouses and third-party billing services will need to be educated on the new ICD-10 codes, as these codes will be present on most claims.
ICD-9 codes should only be submitted on claims with dates of service prior to October 1, 2015. Current regulations require the use of ICD-9 codes for dates of service prior to the mandated implementation date. All submitted claims to MetroPlus with dates of service after October 1, 2015 must use ICD-10 Codes. ICD-9 codes will no longer be accepted for these dates of service. Any claims submitted with the incorrect codes will be denied. ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD-10 code from the right family is submitted, MetroPlus will process the claim.
Offices should familiarize themselves with the process of the ICD-10 change by following these recommended next steps:
Can I Get More Information?
CMS (The Centers for Medicare & Medicaid Services) provides many different additional resources to help you better understand the upcoming ICD-10 initiative.