While mandatory use of ICD-10-CM codes on claims will not begin until October 1, 2013, practices must begin using version 5010 standards for claims much earlier. In fact, the deadline for use of these standards is January 1, 2012. That’s only a few months away, yet many practices do not know if their claims will be 5010-ready or not.
According to a Medical Group Management Association March survey, 56 percent of the 349 physician practices polled had yet to schedule internal 5010 testing, and 61 percent hadn’t scheduled any testing with their major health plans.
While visiting with a cardiology practice in June, I asked what they were doing to get ready for 5010 and ICD-10-CM, and they said “nothing.” They assume their vendors are taking care of everything.
Version 5010 Basics
The 5010 standard covers the following health-care transactions:
837P—Professional Health Care Claims
837I —Institutional Health Care Claims
270/271—Eligibility for a Health Plan
276/277—Health Care Claims Status
835—Health Care Payment and Remittance Advice
Practice administrators should be discussing 5010 with their vendors. Review implementation plans with all your clearinghouses, billing services, and payers. Make sure they are (or will be) testing and ready for the January 1, 2012 deadline.
Ask them if 5010 and ICD-10 will affect your contract. Will there be additional charges because of the changes needed? Will payers change medical-necessity requirements because of the more specific codes that will be available? Will your payers be ready to process claims with the 5010 standards in January 2012? Do they expect to be ready in October 2013 for ICD-10-CM?
The Centers for Medicare & Medicaid Services has a two-page document to help you begin the conversation. You can find “Talking to Your Vendors About
ICD-10 and Version 5010: Tips for Medical Practices” and other ICD-10 resources at www.cms.gov/ICD10.
CMS already set up two national testing days for 5010. The first was June 15, and the second is scheduled for August 24. The agency encourages all trading partners, including providers, clearinghouses and vendors, to participate in the national 5010 testing days.
What to Expect with ICD-10
Once your practice is ready with 5010, then you can begin looking at ways you’ll have to change your diagnosis-coding processes.
One main difference for cardiology practices will be the change in the myocardial infarction codes, which in the ICD-9-CM system include MI with a stated duration of eight weeks or less. In ICD-10-CM, this changes to duration of four weeks (28 days) or less. The coronary atherosclerosis codes now include combination codes with common symptoms and manifestations such as angina.
Cardiac arrest, now one code, will have three codes:
Cardiac arrest due to underlying cardiac condition;
Cardiac arrest due to other underlying condition; and
Cardiac arrest, cause unspecified.
For the first two, the underlying condition will be coded first.
Bradycardia is moving from the cardiac dysrhythmias’ code section to symptoms and signs involving the circulatory and respiratory systems.
Changes Needed
These and other coding changes will require new superbills. A practice might want to assign someone to begin looking at the General Equivalency Mappings (GEMs) published on the CMS website to start this process.
Some coders may need additional training in anatomy or physiology to be able to appropriately code ICD-10-CM. Now is the time to begin this training.
A Google search on ICD-10-CM generates nearly 900,000 hits. You can find help from the following organizations and others:
CMS at www.cms.gov/ICD10
National Center for Health Statistics at http://www.cdc.gov/nchs/icd/icd10cm.htm
American Health Information Management Association at http://ahima.org/icd10/default.aspx
AAPC (formerly American Academy of Procedural Coders) at http://www.aapc.com/ICD-10/
American Hospital Association at http://www.ahacentraloffice.com/ahacentraloffice/shtml/ICD10overview.shtml
All of these organizations are actively involved in the training of personnel (coders and physicians) and planning for the implementation of new processes. Timelines, implementation charts, and code- conversion applications are just some of the resources available.
It’s 2011, and time to ask yourself: Where is your practice?
