ICD 10 - Frequently asked question

1.  Q: What is ICD-10?
A: ICD-10 is the International Classification of Diseases, version 10.  (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopted in 1979.

2.  Q: What changes are occurring in the ICD-10 version?
A: The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure codes.  The changes are as follows:
** The diagnosis codes (ICD-9) are currently three to five digits that are alphanumeric in nature and combine to make around 14,000 unique diagnosis codes being used today. For ICD-10, the diagnosis codes will be seven digits that are alphanumeric in nature and combine to make around 68,000 unique diagnosis codes
** Currently, ICD-9 procedure codes are three to four digits that are numeric in nature and  combine  to  make  about  4,000  unique  procedure  codes.    For  ICD-10-PC  S (inpatient), the procedure codes will be 7 alphanumeric in nature and combine to make around 72,000 unique procedure codes.

3.  Q: What is the primary purpose of this change?
A: The primary purpose of the change to ICD-10 is to improve clinical communication.  It allows for the capture of data about signs, symptoms, risk factors and comorbidities and better describes the clinical issues overall. It will also enable the United States to exchange information across country borders.

4.  Q: What is CarePlus’ plan for ICD-10 acceptance?
A:  CarePlus  will  accept  ICD-9  codes  on  claims  w/  date  of  service  (DOS),  or  discharge  dates  of September 30, 2014 or prior.  CarePlus will accept ICD-10 codes on claims w/ DOS, or discharge dates of October 1, 2014 or after.

5.  Q: Do you plan to be ready to process ICD-10 codes submitted on claims forms by Oct 1, 2013?
A: CarePlus will go live with the ICD-10 codes effective October 1, 2014.

6.  Q: How long will support for both ICD-9 and ICD-10 coding be provided?
A:  CarePlus  will  process  correctly  coded  transactions  within  the  date  ranges  specified  in  the  answers above until the volume of ICD-9 submissions is diminished.

7.  Q: When will CarePlus begin testing transactions?
A: CarePlus will begin testing ICD-10 transactions in the second quarter of 2014.
 
8.  Q: Do you have a communication plan and schedule for customers to keep them informed?

A: The ICD-10 Program team is currently working on a communication plan and schedule with testing partners, trading partners, providers and internal departments.

9.  Q:  Will  your  claims  adjudication  processing  vary  by  contract  type  (e.g.,  hospital, professional provider, and/or ancillary services)?
A: CarePlus does not foresee any issues with claims processing with the change to ICD-10.  Testing will begin in early 2013 to mitigate any such issues.

10. Q:  Will  CarePlus  purchase  any  new  technology  as  part  of  its  preparation  for  ICD-10 implementation?
A: CarePlus is remediating the systems that are currently in place for claims reimbursement. 

11. Q: Will CarePlus be using GEMS as part of its process, or for creating files coming in or out?
A:  CarePlus will process transactions in its “native” format and will not be using GEMS to crosswalk ICD-9 codes and ICD-10 codes for inbound or outbound v5010A1 transactions.

12. Q: Will there be any changes in payment with the change to ICD-10?
A: CarePlus’ plan is to be reimbursement neutral. There should be no change to the way a claim is paid with  ICD-10  and  ICD-9  codes  unless  an  MS-DRG  change  has  taken  place  or  a  contract  has  been rewritten to incorporate a change of reimbursement.
 
13. Q: What claim-processing issues does CarePlus anticipate with the preparation for ICD-10?

A:  CarePlus is investing in remediation of systems and processes to support the ICD-10 requirements. CarePlus  does  not  foresee  any  issues  with  claims  processing  with  the  change  to  ICD-10,  although rejection due to misuse of new codes is possible. Testing will begin in early 2013 to mitigate any such issues.

14. Q: What key information should providers to keep in mind as they develop their own ICD-
10 implementation plans?

A:  CarePlus  suggests  that  providers  stay  up-to-date  on  any  changes  by  CMS  regarding  the  ICD-10 implementation.  This  can  be  done  by  monitoring  the  CMS  website.  If  providers  have  questions  or concerns, they may contact their CarePlus provider associate.

Websites offering additional information on 5010 and ICD 10 are:
** http://www.cms.gov/ICD10/Downloads/Sept132010_ICD10_5010Final.pdf
** http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=220

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