In health care, coding systems are used to differentiate diagnoses and procedures in virtually all treatment settings. These codes are integrated in systems and business processes in provider organizations and health plans, as well as allied businesses. Proper coding is essential in all reimbursement and claim processes.
Currently, the U.S. Department of Health and Human Services (HHS) uses the World Health Organization’s International Classification of Diseases, Ninth Edition, known as ICD-9.
As issued in a final rule from HHS on January 16, 2009, ICD-10-CM (Clinical Modification - diagnoses) and ICD-10-PCS (Procedural Coding System - for inpatient procedures) will become the new coding system for delineating medical diagnoses and procedures for care management and billing purposes.
Originally slated to go into effect on October 1, 2013, the date was later changed to October 1, 2014. The Tenth Edition – ICD-10 – will replace ICD-9 on October 1, 2014.
This transition from ICD-9 to ICD-10 is a provision of the Health Insurance Portability and Accountability Act (HIPAA), as regulated by HHS and the Centers for Medicare & Medicaid Services (CMS). The change to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures.
A Prerequisite to ICD-10
To prepare for ICD-10, HHS also mandated that transaction standards for all electronic health care claims be upgraded to Version 5010 from Version 4010/4010A standards. Every standard – from claims to eligibility and referral authorizations – was updated to Version 5010 before the enforcement discretion period ended on June 30, 2012.
Transitioning Is Not Optional
The federal mandate to transition to ICD-10 pertains to all HIPAA-covered entities including Providers, Payers, Vendors and their business associates. Provider claims not submitted using ICD-10 codes will be pended, denied or rejected. Payments to providers cannot be made without the proper ICD-10 coding. ICD-10 will affect all HIPAA-covered entities, not just those submitting Medicare or Medicaid claims.
The Benefits of ICD-10
ICD-10 is vital to transforming our nation’s health care system. As medical science continues to evolve, so will ICD-10, with benefits including:
- A robust coding infrastructure that contains valuable information to help providers increase case management and care coordination effectiveness.
- Improved quality measurements and patient safety, and the evaluation of medical processes and outcomes.
- The capability to readily expand and capture new procedures and technologies.
DCH is Transitioning, Too
DCH is identifying where ICD codes are used within DCH’s policies, processes and systems, and remediation of the Georgia Medicaid Management Information System (GAMMIS) is underway.
DCH Testing with Trading Partners and Providers
DCH is currently undergoing internal testing using ICD-10 code sets and plans to begin external testing in late 2013.
- Trading Partner testing will start in 4th quarter 2013.
- Provider testing will start in 1st quarter 2014.
To become a Beta Test Site, please e-mail your interest to firstname.lastname@example.org.
ICD-10 Communications and Educational Outreach
To learn more about transitioning to ICD-10, please review the resources shown below and check back often as we continue to update this site.
To join our mailing list for the latest ICD-10 news and information about workshops, webinars, readiness guides and more, send us a note at AskDCH@dch.ga.gov.
For the latest ICD-10 updates, implementation checklists, timelines and more, visit the CMS website.
- FACT SHEET – Transitioning from ICD-9 to ICD-10 Code Sets – February 2014 – Posted 02/17/14
- FACT SHEET – ICD-10 Remediation Project - February 2014 – Posted 02/17/14
- ICD-10 FAQ Brochure - Updated 01/29/13
- ICD-10 Remediation Project FAQ - Vol.1, Update 03/22/13
- ICD-10 FAQ - Vol. 2, - Posted 8/8/13
- Video Series (Four Parts): "Preparing for Implementation" - Posted 03/25/13