ICD-10 Conversion: Why is this Important?

Important Dates:

  • January 1, 2012 - ALL providers must upgrade to Version 5010 in order to accommodate ICD-10 codes
  • October 1, 2013 - ICD-10 codes must be used for all procedures and diagnosis on and after this date. Claims with ICD-9 codes for services provided on or after October 1, 2013 cannot be paid

In health care, coding systems are used to differentiate diagnoses and procedures in virtually all treatment settings. Diagnostic and procedural codes are connected to nearly every system and business process in health plans and provider organizations, including reimbursement and claim processes.

The World Health Organization's Ninth Revision, International Classification of Diseases (ICD-9) is the official system of assigning codes to report diagnoses and procedures in the United States. On October 1, 2013, the ICD-9 code sets will be replaced by ICD-10 code sets. The U.S. Department of Health and Human Services issued a final rule on January 16, 2009, adopting ICD-10-CM (clinical modifier) and ICD-10-PCS (procedure coding) system. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, 2012. ICD-10 diagnoses codes must be used for all health care services provided in the U.S. on or after October 1, 2013. ICD-10 procedure codes must be used for all hospital inpatient procedures performed on or after October 1, 2013. Claims with ICD-9 codes for services provided on or after October 1, 2013, cannot be paid.

ICD-9 follows an outdated 1970's medical coding system which fails to capture detailed health care data and is inconsistent with current medical practice. By transitioning to ICD-10, providers will have:

  • Improved operational processes by classifying detail within codes to accurately process payments and reimbursements
  • Detailed information on condition, severity, comorbidities, complications and locations
  • Detailed health reporting and analytics such as cost, utilization and outcome
  • Expanded coding flexibility by increasing code length to seven characters

DCH's Role
ICD-10 will affect diagnosis and procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Everyone covered by HIPAA who transmits electronic claims must switch to Version 5010 transaction standards. The change to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures.

DCH is currently working to identify where ICD codes are used within DCH's policies, processes and systems. We are identifying the work effort required to transition to ICD-10 as well as the tasks necessary to remediate the Medicaid Management Information System (MMIS). The ICD-10 implementation will improve DCH's ability to accurately compensate Medicaid providers, and reduce the incidence of improper payments.

Providers' Role
As a provider, you should talk with your software vendor to ensure your system will be upgraded to Version 5010 by January 1, 2012.

Contact us at: [email protected]. To learn more about ICD-10 Conversion, please read: