The United States Department of Health and Human Services (HHS) ruled on 7/31/14 that ICD-10-CM and ICD-10-PCS will be implemented into the HIPAA mandated code set on October 1, 2015. This will make the US coding set in compliance with the coding schemes of the rest of the world. As such, you must prepare accordingly.
- On or after 10/1/15: MUST comply with the ICD-10. Failure to comply means the claims will not be processed.
- Before 10/1/15: claims for services and in patient procedures provided before the compliance date must use IDC-9 codes.
According to HHS/CMS, ICD-10 applies to everyone covered under HIPPA.
- What should providers do to prepare for the transition to ICD-10? Providers should plan to test their ICD-10 systems early, to help ensure compliance. Beginning steps in the testing phase include:
> Internal testing of ICD-10 systems
> Coordination with payers to assess readiness
> Project plan launch by data management and IT teams
For providers who have not yet started to transition to ICD-10, below are actions steps to take now:
> Develop an implementation plan and communicate the new system changes to your organization, your business plan, and ensure that leadership and staff understand the extent of the effort the ICD-10 transition requires.
> Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, work flow changes during and after implementation, and contingency planning.
> Talk with your payers, billing and IT staff, and vendors to confirm their readiness status.
> Coordinate your ICD-10 transition plans among your partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
> Create and maintain a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, resources needed, and estimated start and end dates.
- Where can I find the ICD-10 code sets?
> The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge at cms.gov/ICD10.
Please visit the F.A.Q on the CMS website for more information: