Countdown to ICD-10: 10 Facts About ICD-10

CMSHHSgov
17 Jul 201503:14
EducationalLearning
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TLDRThe transition to ICD-10 is approaching, with the deadline set for October 1, 2015. Despite the 68,000 codes, practices will only use a small subset, and the process of looking up codes remains the same with the help of an alphabetic index and electronic tools. Outpatient and office procedure codes (CPT codes) will not change. Medicare providers can test their systems with CMS before the deadline. If unprepared, practices can use free billing software or submit paper claims, adhering to the waiver provisions. Claims for services after October 1 must use ICD-10 codes, but reimbursement will still be based on CPT codes. The switch to ICD-10 is expected to be cost-effective and will enhance healthcare through better patient care coordination, disease tracking, and support for quality-driven payment models.

Takeaways
  • 📅 ICD-10 Transition Date: The switch to ICD-10 is set for October 1, 2015.
  • 📈 Code Quantity: Although ICD-10 includes 68,000 codes, practices will only use a small subset relevant to them.
  • 🔍 Code Lookup Process: The method of looking up codes remains unchanged, with the help of an alphabetic index and electronic tools.
  • 🏥 Consistent Coding: Outpatient codes and office procedure codes will not change; practices will continue using CPT codes.
  • 📊 System Testing: Medicare providers have the opportunity to test their systems with CMS before the transition date.
  • 🤝 Acknowledgment Testing: Practices can conduct acknowledgment testing with their Medicare Administrative Contractor (MAC) at any time.
  • 💻 Free Billing Software: If systems aren't ready for electronic claims on October 1, free billing software is available for download from every MAC.
  • 📰 Paper Claims Option: Paper claims can still be submitted if the waiver provisions in the law are met.
  • 🚫 ICD-10 Deadline: Only claims using ICD-10 codes will be accepted for services provided on or after October 1, 2015.
  • 💰 Reimbursement Determination: Reimbursement for outpatient and physician office procedures will still be based on CPT codes, which remain unchanged.
  • 🌟 Benefits of ICD-10: The more specific codes in ICD-10 will improve patient care coordination, disease outbreak tracking, and support innovative payment models for quality care.
  • 💼 Cost of Transition: The cost of switching to ICD-10 may be lower than expected, with many vendors including the new codes in upgrades at minimal or no cost.
Q & A

  • What is the ICD-10 transition date?

    -The ICD-10 transition date is October 1, 2015.

  • How many codes does ICD-10 include?

    -ICD-10 includes 68,000 codes.

  • Are all ICD-10 codes required to be used by a practice?

    -No, a practice will only use a small subset of the available codes.

  • Has the process of looking up a code changed with ICD-10?

    -The process of looking up a code stays the same, with the help of an alphabetic index and electronic tools.

  • Are outpatient codes and office procedure codes changing with ICD-10?

    -No, outpatient codes and office procedure codes remain the same.

  • What codes will practices continue to use for outpatient procedures and physician office claims?

    -Practices will continue to use CPT codes for outpatient procedures and physician office claims.

  • How can Medicare fee-for-service providers test their systems with CMS before the transition date?

    -All Medicare fee-for-service providers can have a chance to test their systems with CMS before October 1.

  • What options are available if a practice isn't ready to submit claims electronically on October 1?

    -They can use free billing software, the Part B claims submission portal, or submit paper claims if they've met the waiver provisions.

  • Which codes will be accepted for services provided on or after October 1, 2015?

    -Only claims that use ICD-10 codes will be accepted for services provided on or after October 1, 2015.

  • How will the reimbursement for outpatient and physician office procedures be determined?

    -The reimbursement will still be based on CPT codes, which remain unchanged.

  • What are some benefits of the more specific ICD-10 codes?

    -The benefits include better coordination of patient care, improved tracking of disease outbreaks and adverse drug reactions, and support for innovative payment models that drive quality of care.

  • Is the cost of switching to ICD-10 expected to be high?

    -The cost may be much lower than expected, as many vendors are including the new codes in their upgrades at little or no cost to customers.

Outlines
00:00
📚 Introduction to ICD-10 Transition

The video script begins with an introduction to the transition to ICD-10, highlighting the upcoming deadline of October 1, 2015. It emphasizes that while ICD-10 includes 68,000 codes, medical practitioners will only need to use a small subset relevant to their practice. The process of looking up codes remains the same, with the help of an alphabetic index and electronic tools. The script reassures viewers that outpatient and office procedure codes (CPT codes) will not change, and that there will be opportunities for Medicare providers to test their systems before the transition date. It also outlines alternative options for submitting claims if electronic systems are not ready by the deadline, including the use of free billing software, the Part B claims submission portal, and paper claims under certain conditions. The script stresses that only claims using ICD-10 codes will be accepted for services provided on or after October 1, 2015, and that reimbursement for outpatient and physician office procedures will still be based on CPT codes. The video encourages viewers to start preparing for the transition, highlighting the benefits of more specific codes for patient care coordination, disease outbreak tracking, and support for innovative payment models. It concludes with a call to action to visit CMS.gov/ICD10 for more information.

Mindmap
Keywords
💡ICD-10
ICD-10 stands for the International Classification of Diseases, 10th Revision, which is a coding system used in healthcare for diagnosing and classifying diseases and procedures. In the video, it is highlighted as an upcoming transition for healthcare providers, with a specific transition date of October 1, 2015. ICD-10 is important because it includes more detailed and specific codes, which can improve patient care coordination, disease tracking, and support innovative payment models.
💡Transition
In the context of the video, 'transition' refers to the process of moving from the previous ICD coding system (ICD-9) to the new ICD-10 system. This changeover involves updating software, training staff, and modifying procedures to accommodate the more extensive and detailed ICD-10 codes. The transition is crucial for healthcare providers to continue operating efficiently and to ensure accurate record-keeping and reimbursement from insurance providers.
💡Coding
Coding in healthcare refers to the assignment of codes to diagnoses, procedures, and other health information. These codes are used for various purposes, including billing, statistical analysis, and tracking of health trends. The video discusses the process of looking up codes and how it remains the same with ICD-10, albeit with a much larger number of codes to choose from.
💡CPT codes
CPT codes, which stands for Current Procedural Terminology codes, are a standardized set of codes used by healthcare providers primarily in the United States to report medical procedures and services to insurance companies. In the video, it is clarified that despite the transition to ICD-10, outpatient procedures and physician office claims will continue to use CPT codes, indicating that this system remains unchanged for these specific types of medical services.
💡Medicare
Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and over, as well as certain younger individuals with disabilities. In the context of the video, Medicare plays a significant role as it is mentioned that all Medicare fee-for-service providers are required to test their systems with CMS before the ICD-10 transition date. This ensures that they are prepared for the changeover to the new coding system.
💡Acknowledgement testing
Acknowledgement testing is a process where healthcare providers verify that their systems can successfully transmit and receive electronic data, such as claims, from insurance companies or other healthcare entities. In the video, it is mentioned as a part of the preparation for the ICD-10 transition, allowing providers to confirm that their systems are ready for the new coding system.
💡Billing software
Billing software is a type of program used by healthcare providers to manage and submit claims for services rendered to patients and insurance companies. The video mentions that if a practice's system isn't ready to submit claims electronically by the ICD-10 transition date, they can use free billing software available for download from every Medicare Administrative Contractor (MAC) jurisdiction.
💡Part B claims submission portal
The Part B claims submission portal is an online system used by healthcare providers to submit claims for services covered under Medicare Part B, which includes physician and outpatient services. In the video, it is mentioned as one of the options available to providers for submitting claims using ICD-10 codes in jurisdictions where the portal is accessible.
💡Paper claims
Paper claims refer to the traditional method of submitting claims on physical forms, as opposed to electronic submission. The video mentions that even after the transition to ICD-10, providers who are not ready to submit claims electronically can still submit paper claims, provided they meet certain waiver provisions. This highlights the flexibility offered to healthcare providers during the transition period.
💡Reimbursement
Reimbursement in healthcare is the process of paying a provider for the medical services that were rendered. The video clarifies that the reimbursement for outpatient and physician office procedures will not be determined by the new ICD-10 codes but will still be based on CPT codes. This means that while ICD-10 codes are used for diagnosis and classification, the payment structure remains linked to the CPT codes.
💡Medical necessity
Medical necessity refers to the requirement that healthcare services or procedures must be appropriate and necessary for the diagnosis or treatment of an illness or injury. In the context of the video, ICD codes, including the new ICD-10 codes, may be used to verify medical necessity, ensuring that the services provided are justified and meet the criteria set by insurance providers and regulatory bodies.
💡Healthcare providers
Healthcare providers are professionals or institutions that deliver healthcare services, such as doctors, nurses, hospitals, and clinics. In the video, the term is used to refer to the individuals and organizations that will be affected by the transition to ICD-10, as they need to update their systems and practices to accommodate the new coding system.
Highlights

ICD-10 transition date is set for October 1, 2015.

ICD-10 includes 68,000 codes, but only a small subset will be used in practice.

The process of looking up codes remains the same with the help of an alphabetic index and electronic tools.

Outpatient codes and office procedure codes will not change; CPT codes will continue to be used.

Medicare fee-for-service providers can test their systems with CMS before the transition date.

Practices can conduct acknowledgement testing with their Medicare Administrative Contractor (MAC) at any time.

If systems aren't ready by October 1, claims can still be submitted using free billing software or paper claims, adhering to the waiver provisions.

Only claims using ICD-10 codes will be accepted for services provided on or after October 1, 2015.

Reimbursement for outpatient and physician office procedures will still be based on CPT codes.

ICD codes are used to verify medical necessity.

The cost of switching to ICD-10 may be lower than expected, with many vendors including the new codes in their upgrades at little or no cost.

Transitioning to ICD-10 can improve the future of health care through more specific codes.

The benefits of ICD-10 include better coordination of patient care, improved tracking of disease outbreaks, and support for innovative payment models.

For more information, visit CMS.gov/ICD10.

ICD-10 codes will aid in tracking adverse drug reactions.

The transition to ICD-10 is crucial for supporting quality of care through innovative payment models.

Transcripts

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