August 10, 2011

Frozen Codes and ICD-10 Implementation: What Does It Mean for Providers?


We are all aware that ICD-10-CM and ICD-10-PCS codes are around the corner and that, even now, changes are occurring to prepare for the Oct. 1, 2013, implementation. But, are we all aware of the code freeze that will start Oct. 1, 2011, and continue until Oct. 1, 2014, well after the transition of ICD-9-CM to ICD-10.

As we approach the upcoming transition, questions arise about the interim changes.  A few commonly asked questions and answers are provided below.

Is This Going to Affect My Facility/Practice?

Yes. Any organization that utilizes ICD-9-CM will be affected, as well as Medicare fee-for-service physicians, providers, suppliers and other entities who submit claims to Medicare contractors for procedures and services provided to Medicare beneficiaries in any healthcare setting.

When Will the Coding Freeze Occur?

During its Sept. 25, 2010, meeting, the ICD-9-CM Coordination and Maintenance Committee indicated that it had finalized the decision to implement a partial freeze for both ICD-9 CM and ICD-10 code sets. A schedule of implementation dates is provided below.

    • Last regular update not affected by the code freeze will take place Oct. 1, 2011.
    • Only limited code updates will be made for the October 1, 2012, update for both ICD-9-CM and ICD-10 code sets to capture new technology and new diseases.
    • Again, on Oct. 1, 2013, only limited code updates will be made to ICD-10 code sets to capture new technology and new diseases.
    • And, of course, the day we have all been awaiting: Beginning Oct. 1, 2013, there will be no updates to ICD-9-CM, since ICD-10 will be in place. ICD-9-CM will no longer be a HIPAA standard.
    • Regular ICD-10-CM updates will not take place until Oct. 1, 2014.

The ICD-9 Coordination and Maintenance Committee will continue to meet twice a year during the code-freeze time period. Remember that even though ICD-10 replaces ICD-9-CM on Oct. 1, 2013, the code freeze will still be in effect, which gives all of us time to prepare as well as identify needed codes within ICD-10 that have been missed during the implementation.

Although we still have more than a year until ICD-10-CM takes place, providers must start using the new version of HIPAA transaction standards known as 5010 by Jan. 1, 2012, since the current version 4010/4010A1 does not accommodate use of the ICD-10 codes.

Speak Up!

Those who are already preparing for ICD-10 have found that there isn’t always a diagnosis code that best describes a patient’s diagnosis or condition. During the ICD-9 Coordination and Maintenance Committee meetings, the public is allowed, and encouraged, to comment on whether or not requests for new diagnosis and procedure codes should be created going forward. This is the time for all of us to speak out about our coding concerns and opportunities for the ICD-10 implementation. For example, requests for new diagnosis and procedure codes should be submitted based on the need to capture new technology or disease.



Make the Choice to be Proactive

From this point forward, providers must decide whether they want to be proactive or reactive. Now is the time to make your choice about this—and, if you choose to be proactive, which you should, start preparing for ICD-10 now.

Preparation includes staff education and implementation on the process for the assignment of ICD-10 diagnosis codes. Here are a few steps that will get you started.

    • Evaluate your coders to identify whether they need more education in anatomy or physiology, which is required to appropriately assign ICD-10 diagnosis codes.
    • Check to see whether super-bills need to be changed to get ready for ICD-10.
    • Take the opportunity to be a public voice during the ICD-9 Coordination and Maintenance Committee meetings to ensure that new technology or diseases are captured for accurate diagnosis assignment.

About the Author

Patricia A. Shell is a senior healthcare consultant with Medical Learning, Inc. (MedLearn®), St. Paul, MN. She has more than 30 years of experience in billing, coding, and compliance.

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Read 97 times Updated on September 23, 2013