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ICD-10 Transition PDF Print E-mail
Thursday, 09 September 2010 11:14

Going forward, on October 1, 2013, the ICD-10 codes sets will be used to report medical diagnoses and inpatient procedures.  As per the compliance timeline, the transaction standards used for electronic healthcare claims must be upgraded from Version 4010/4010A to Version 5010 to adapt with ICD-10 code structure by January 1, 2012. 

The details below provide information on ICD-10 transition, resources, and general guidance on how to gear up for it.

About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, Clinical Modification/Procedure Coding System, 10th Edition) consists of two parts:

  • ICD-10-CM for diagnosis coding
  • ICD-10-PCS for inpatient procedure coding
Who Needs to Transition PDF Print E-mail
Thursday, 09 September 2010 11:23

The impact of ICD-10 diagnosis and inpatient procedure coding will be on everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The switch over to ICD-10 does not impact CPT coding for outpatient procedures. Version 5010 transaction standards must be used by everyone covered by HIPAA who transmits electronic claims.  Billing services, clearinghouses, payers, health care providers, and other organizations must be geared up to comply with the Version 5010 and ICD-10 transitions, which implies:

By January 1, 2011; all the billing services, clearinghouses, payers, health care providers, and other organizations that conduct electronic transactions should accomplish internal testing of Version 5010 systems in time to begin external testing with each other.

All claims submitted electronically on or after January 1, 2012, must use Version 5010 transaction standards. Claims submitted electronically that do not use Version 5010 standards cannot be paid.

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ICD-10 Corner

9 benefits of ICD-10

1. Measuring the quality, safety and efficacy of care
2. Designing payment systems and processing claims for reimbursement
3. Conducting research, epidemiological studies, and clinical trials
4. Setting health policy
5. Operational and strategic planning and designing healthcare delivery systems
6. Monitoring resource utilization
7. Improving clinical, financial, and administrative performance
8. Preventing and detecting healthcare fraud and abuse
9. Tracking public concerns and assessing risks of adverse public health events

More details..

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