Frequently Asked Questions about ICD-10
- ICD-10-CM – The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all U.S. healthcare treatment settings. Diagnosis coding under this system uses 3 to 7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM.
- ICD-10-PCS – The procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings ONLY. The new procedure coding system uses 7 alpha or numeric digits, while the ICD-9-CM coding system uses 3 or 4 numeric digits.
Providers can get an overview on the CMS website.
What is NMHC’s position on the final ICD-10 rules?
We plan to meet all applicable ICD-10 compliance timeframes. We also continue to work closely with providers and our clearinghouse Emdeon in exchanging information in preparation for ICD-10 implementation and compliance.
We will continue working on our ICD-10 projects to ensure that our systems, vendor tools, and business processes and policies will be ready for the new compliance date. We’ll follow guidance from the Department of Health and Human Services and Centers for Medicare & Medicaid Services. We will work closely with the medical community to monitor compliance and manage risk.
Why is the U.S. switching from ICD-9 to ICD-10?
To increase specificity to support quality metrics and reporting; to support more accurate reporting of diagnoses; to prevent coding errors; to improve patient safety, and to decrease the opportunity to commit patient fraud.
When must I start submitting ICD-10 codes on my claims?
October 1, 2015.
Who must comply with ICD-10?
All HIPAA-Covered Entities.
Will NMHC continue to accept ICD-9 codes after October 1, 2015?
You must submit your standard transactions with ICD-10 codes as of October 1. After that date, NMHC will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the compliance date. We will continue to follow communications from the regulatory authorities and will adapt our approach as permitted.
What will happen to claims filed after October 1 with ICD-9 coding?
NMHC will deny claims not filed with ICD-10 coding.
What is a clearinghouse, and what role does it play in ICD-10 coding?
In medical billing, a clearinghouse is a company that acts as an intermediary and forwards claims information from healthcare providers to insurance payers. Clearinghouses check the claim for errors (“claims scrubbing”) and verify that it is compatible with the payer software.
The clearinghouse also checks to make sure that the procedural and diagnosis codes being submitted are valid and that each procedure code is appropriate for the diagnosis code submitted with it. Providers should make sure their clearinghouses are ready for ICD-10 coding.
What type of training will my staff and I need?
Training needs will vary depending on your practice, specialty, and practice setting. When assessing training needs for ICD-10, consider training for your entire staff. Clinicians and billing staff should receive documentation training and coding training, respectively, and other staff should have ICD-10 overview training. Specialty societies and training vendors offer specialty-specific ICD-10 training, online and in person. Training should also include practice coding using real patient data from your practice. Some EHR software vendors will partner with training vendors and offer tools to assist with practice coding.
What resources are there available for me and my staff to learn more about ICD-10?
Providers can learn more about ICD-10 at the following websites:
CMS (for small practices): http://www.roadto10.org/
AAPC ICD-9 to ICD-10 reference sheet
Emdeon Clearinghouse: http://www.emdeon.com/5010/icd10/
Can I send test ICD-10 claims to NMHC?
Yes! Please review the Emdeon EDI Provider Testing Information and the Emdeon ICD-10 Submitter Provider Quick Start Guide. Then submit your test ICD-10 claim to Emdeon, NMHC’s clearinghouse vendor.
Where can I find a list of ICD-10 codes?
The ICD-10-CM and ICD-10-PCS code sets, as well as the official ICD-10-CM guidelines, are available free of charge on the 2015 ICD-10-CM and GEMs and 2015 ICD-10-PCS and GEMs pages of the CMS ICD-10 website. Additionally, it is important to contact your payers and trading partners to request a copy of the crosswalk mapping tool they are using to ensure its accuracy.
How will NMHC handle split claims?
In general, NMHC is following CMS guidance, which states that for reoccurring/series accounts or interim-bills, claims should be split. Services before October 1, 2015 should be billed with ICD-9 codes; services on or after October 1, 2015 should be billed separately with ICD-10 codes.
When will NMHC begin to accept ICD-10 authorizations and codes for procedures?
We intend to have a seamless transition and ensure appropriate and timely authorization of and payment for services. Starting on September 1, 2015, NMHC will accept both ICD-9 and ICD-10 codes for authorization purposes. ICD-9 authorizations received prior to October 1 for services after October 1, 2015 will be accepted.
Starting October 1, 2015, all authorizations need to be in ICD-10. For inpatient services, any discharges on or after October 1, 2015 should be billed with ICD-10 codes. Any discharges before October 1, 2015 should be billed with ICD-9 codes.