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ICD-10

 
 

Transition Deadline to ICD-10 Is October 1, 2015

The implementation of the transition to ICD-10 Code Sets has been delayed by federal law (HR 4302) until at least October 1, 2015.

While the Georgia Department of Community Health (DCH) will comply with this federal law, the department will continue its initiative for system remediation, internal and external testing, and provider awareness and provider education as scheduled.

DCH encourages all providers, trading partners, clearinghouses and other stakeholders affected by the federally mandated transition to continue moving forward with transition plans.

Background 

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. The transition takes place on October 1, 2015.

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.

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. For services rendered on or after the compliance date 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

The Department of Community Health (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. It will be completed in time for the mandated transition date of October 1, 2015.

DCH Testing with Providers and Trading Partners

DCH has undergone internal testing using ICD-10 code sets and began external testing in early 2014 for providers and trading partners.

To become a Beta Test Site, please e-mail your interest to icd10project@dch.ga.gov. Please check back for testing updates.

For more information, visit our Frequently Asked Questions.