MDS Alert

Published on Wed Jun 02, 2010 PDF

The government also wants to freeze ICD-9 coding changes after next year.

CMS just can't seem to dispel rumors about a delay in the Oct. 1, 2013, ICD-10 implementation date. "There will be no delays on this implementation period, and no grace period," said Pat Brooks with CMS' Hospital and Ambulatory Policy Group, during a June 15

Centers for Medicare & Medicaid Services Open Door Forum entitled "ICD-10 Implementation in a 5010 Environment."

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist. Providers should spread the word that the rumor is untrue, she urged.

Currently, CMS publishes about 14,000 ICD-9 codes, but there are more than 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

You can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site at www.cms.gov/icd10. "Later this year, we'll be posting the 2011 update," Brooks said during the call.

In addition, you can review general equivalence mappings (GEMs) if you'd like information on how to convert data from ICD-9 to ICD- 10 or vice-versa. The GEMs can be helpful if you're converting lists, systems, or applications from one system to another.

"Some people refer to these as crosswalks, others call them mapping, but they're basically forward and backward mapping between the coding systems," Brooks said.

However, "the GEMs are not a substitute for learning how to code ICD- 10, and, frankly, for some of you who have small projects with just a few codes, you may not want to bother with the GEMs; it's probably just quicker to pick up an ICD-10 code book and use that rather than the GEMs," she pointed out.

Vendors, payers, and coding educators have asked CMS to freeze the current diagnosis codeset to helpmake ICD-10 transition planning simpler. CMS therefore created a proposal under which it would update the ICD-9 codeset one last time on Oct. 1, 2011. After that, no ICD-9 codes will be added to the set except for those updates required for new technologies and diseases. Regular updates to ICD-10 would begin on Oct. 1, 2014, under the proposal.

"We plan to make a final decision on any code freeze and announce it at the September ... 2010 ICD-9 Coordination and Maintenance Committee meeting," Brooks said.

In preparation for the use of ICD-10, CMS has introduced its new HIPAA 5010 form, which will be required for all HIPAA-covered entities (i.e., providers, health plans, clearinghouses, and their business associates, including billing agents) as of Jan. 1, 2012, said Christine S tahlecker of CMS' Office of Information Services, during the call.

Although CMS has noted the fact that the new 5010 form is a prerequisite for ICD-10 implementation (due to its increased field sizes and increased number of diagnosis codes allowed on a claim), the agency also stressed the fact that the new 5010 does not do the ICD-10 prep work for you.

"With our 5010 project, we are not adding any processing of the ICD-10 code values, and we are not including any crosswalk from ICD- 9 to ICD-10," Stahlecker said. "So although the 5010 form permits both the ICD-9 and ICD-10 code values, only ICD-9 will continue to be processed up until the ICD-10 project permits ICD-10 codes to come in."

Timeline: Keep in mind that CMS will begin accepting 5010 forms effective Jan. 1, 2011, and use of the form will be required as of Jan. 1, 2012. The ICD-10 codes will take effect on Oct. 1, 2013.

If you're not ready to submit  the 5010 form by Jan. 1, 2012,"you will no longer be able to submit electronic transactions" to Medicare, Stahlecker said. "Providers that are submitting paper claim forms today should not experience a change in that paper claim form for 5010 or the ICD-10 projects. Our understanding is at this time, those paper claim forms can already accommodate the additional length of the diagnosis codes," Stahlecker said.

Stay tuned: CMS will present a follow-up conference call regarding  ICD-10 on Sept. 13, said Hazeline Roulac, a health insurance specialist with CMS.

Resource: CMS has posted 10 new frequently asked questions about ICD-10. The FAQs are at www.cms.gov/ICD10. Select the "Medicare Fee-for-Service Provider Resources" link on the left side of the page, scroll down the page to the "Related Links Inside CMS" section, and select "ICD-10 FAQs." For more information on ICD-10, visit www.cms.gov/ICD10/02b_Latest_News.asp.