April 10, 2011

Let’s Make ICD-10 the Talk of the Town

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“We need to talk.”

Those words generally tend to make people nervous, but we really do need to talk about the move to ICD-10-CM and ICD-10-PCS (hereafter referred to as the ICD-10 code sets). The more we talk, the more we all can contribute toward mitigating the anxiety associated with this massive and important change to how medical diagnoses and inpatient hospital procedures will be coded and reported. If payers, providers, trading partners, medical societies and the other various components of the entire healthcare industry work together to foster open, ongoing communication about progress toward preparing for the Oct. 1, 2013 implementation date for the ICD-10 code sets, it will help assure a smoother and more seamless transition.

Not surprisingly, the Centers for Medicare & Medicaid Services (CMS) outreach efforts have demonstrated that knowledge of the ICD-10 code sets is limited in smaller organizations and noticeably broader among larger provider, payer and vendor organizations. CMS found that smaller healthcare providers are taking a “wait-and-see” attitude, expecting CMS, vendors, larger providers and payers to inform them about the transition and what to do. So clearly we do have some talking to do in the healthcare industry.

For some time now, CMS and other payer organizations have been communicating more general information about the ICD-10 code sets through provider outreach and educational programs. However, it would behoove payers and providers to talk specifically about how they can work together to assure that appropriate processing of claims on the effective date and beyond will achieve consistent and predictable payment results. This kind of partnership would provide opportunities to communicate about:

Whether each of the partnering entities intends to fully remediate/convert all systems to process the ICD-10 code sets versus implementing a temporary internal mapping solution that would forward- and/or backwards-map ICD-9 and ICD-10 codes for some applications;
How mapping decisions and rationale will be communicated to impacted trading partners; and
Potential contract issues or conflicts in areas in which payments currently are driven by ICD-9-CM diagnosis and/or procedure codes.

It will be very important for payers and providers to communicate clearly about how claims with dates of service of Oct. 1, 2013 and later will be processed and paid. If the ICD-10 codes submitted on a claim can be mapped back to ICD-9 codes for internal processing, the payer will need to be able to communicate the payment decisions back to providers and determine how to make business rules regarding mapping decisions fully transparent and available for external review.

Payers, providers, vendors and other HIPAA-covered entities impacted by the transition to the ICD-10 code sets can contribute to fostering communication and awareness in a variety of ways, namely by following these guidelines:

    • Know where the official ICD-10 resources are (www.cms/gov/ICD10), and pass the word.
    • Attend as many ICD-10 educational sessions as possible.
    • Volunteer to share best practices and lessons learned at the local, state or national level.
    • Join ICD-10 strategy and implementation workgroups sponsored by industry leaders such as America’s Health Insurance Plans (AHIP) and the Workgroup for Electronic Data Interchange (WEDI).
    • Reach out for help if you are behind in your impact assessment and planning efforts.
    • Complete industry readiness surveys when issued by CMS.


We are all in this transition to ICD-10 together, and true collaboration is the key to success.  

About the Author

Nancy Engel, RHIT, CCS, has more than 35 years of experience in the health information management (HIM) profession. Nancy currently serves as Manager of Facility Reimbursement Coding Principles for United Healthcare, located in Edina, MN.  In this role, Nancy has responsibility for ensuring the accurate application of facility coding and reimbursement practices across one of the largest health insurance plans in the U.S.  Her previous positions include assistant director of HIM for a large university hospital, HIM consultant and coding manager.

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Read 29 times Updated on September 23, 2013