On October 1, 2015, the United States health care industry will transition from the International Classification of Diseases, 9th Edition (ICD -9), to the International Classification of Diseases, 10th Edition (ICD-10), for medical diagnosis and inpatient procedure coding. ICD-10 diagnosis codes must be used for all health care services provided in the U.S. ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with the ICD-9 codes for services provided on or after the compliance deadline cannot be processed. ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accessibility Act (HIPAA). Health care providers, payers, clearinghouses and billing services must be prepared to comply with the transition to ICD-10.
Does your office have limited resources and not yet purchased ICD-10 upgrades?
Beginning October 1, 2015, Xpress claims will display ICD-10 diagnosis codes for providers apply on new claim submissions for dates of service on or after the October 1, 2015, implementation date. This is a single claim entry option (one at a time).
Go to myTRICARE.com’s provider portal “Join myTRICARE” and sign up to use Xpress claims as your office alternative for TRICARE claims submission with ICD-10.
What should providers be doing?
Health care providers are encouraged to look for specialty-specific ICD-10 training offered by societies and professional organizations. ICD-10 coding training will be integrated into the continuing education units (CEUs) that certified coders must take to maintain their credentials. ICD-10 resources and training materials will be available through CMS, professional associations, software and systems vendors.
CMS’ recommended training time suggests that health care providers start intensive training no sooner than six to nine months prior to the implementation for coders who will prepare to assign ICD-10CM/PCS codes by October 1, 2015. Hospital inpatient coders will need to have 50 hours ICD-10-CM/PCS training. Other coders will require 16 hours of ICD-10-CM.
Health care providers will also need to confirm that billing services, clearinghouses and practice management software vendors are ready to provide the support necessary to meet the compliance date.
CMS has a dedicated website cms.gov/ICD10 that provides the latest information on training opportunities for health care providers.
The fiscal intermediary for the South Region-PGBA and Humana Military are working closely together to ensure the claim system for TRICARE South Region claims is prepared. GO LIVE for implementation of ICD-10 claims processing is October 1, 2015.
Disclaimer: The information provided here is a high level summary of certain provisions of the health care reform law. Provider Education for the South Region has created this webpage to assist in educating provider offices on the ICD-10 readiness and implementation by October 1, 2015 and should not be used as a basis for decisions regarding how health care reform law will affect providers and their offices/facilities.
Tips to prepare for ICD-10 implementation