When do I have to convert to ICD? All services and discharges on or after October 1, must be coded using the ICD code set. The necessary system and workflow changes need to be in place by the compliance date in order for you to send and receive the ICD codes.
Any ICD-9 codes used in transactions for services or discharges on or after October 1, will be rejected as non-compliant and the transactions will not be processed. You will have disruptions in your transactions being processed and receipt of your payments. Physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur. Will the compliance date for ICD be delayed?
Do not expect there to be a delay in the ICD compliance deadline. Work within Medicare to upgrade to the ICD transactions is on target and they expect to be ready on time. Learn more about IDC Facebook Twitter LinkedIn Email. Related Posts. When the U. It also provides better data for measuring and tracking health care utilization and the quality of patient care. National Center for Health Statistics. Section Navigation. Facebook Twitter LinkedIn Syndicate. What is it? A primary user of ICD codes includes health care personnel, such as physicians and nurses, as well as medical coders, who assign ICDCM codes to verbatim or abstracted diagnosis or procedure information, and thus are originators of the ICD codes.
ICDCM codes are used for a variety of purposes, including statistics and for billing and claims reimbursement. The new codes must be supported by medical documentation. Because the updated codes are much more specific, providers will be required to spend more time preparing supporting medical documents in order to use the more specific ICD codes.
However, use of unspecified codes will be allowed to capture less specific information. As plans and providers become accustomed to the new code sets, the more specific ICD also may reduce the rate of denials, rejected or pending payments. Health Care Providers: Any provider of medical or other health services or supplies who transmits any health information in electronic form in connection with a transaction for which standard requirements have been adopted.
Health Plans: Any individual or group plan that provides or pays the cost of health care. The new codes will mean new coverage policies, new medical review edits and new reimbursement schedules.
Health Care Clearinghouses: A public or private entity that transforms health care transactions from one form to another. A: The transition to ICD will affect every system, process and transaction that contains or uses a patient diagnosis or procedure code. Direct effects to state Medicaid plans include coverage and payment determinations; medical review policies; plan structures; statistical reporting; actuarial projections; fraud and abuse monitoring; and quality measurements.
Medicaid programs, for example, frequently implement health policy by flagging or restricting diagnostic codes or by restricting procedure codes to certain diagnosis codes—payment may be denied for emergency services for certain diagnoses that are not considered emergent.
Medicaid also requires prior authorization for certain diagnosis codes; uses these codes to define whether a service qualifies for improved federal match, such as for family planning; and uses them to determine whether a service—such as mental health— is covered Medicaid providers and health plans will purchase or upgrade computer hardware and software to handle the new ICD codes, which are seven characters long rather than five for ICDCM diagnoses and four for procedures and contain alphanumeric variables.
In addition, there will be costs to train coders and program, administrative and systems staff, and possible reductions in productivity while coders and other users become familiar with the updated ICD codes.
Assign overall responsibility and decision-making authority for managing the transition. This can be one person or a committee depending on the size of your organization. Plan a comprehensive and realistic budget. This should include costs such as software upgrades and training needs. Adhere to a well-defined timeline that makes sense for your organization Establish a governance plan to communicate with external partners Ensure involvement and commitment of all internal and external stakeholders.
Contact vendors, physicians, affiliated hospitals, clearinghouses, and others to determine their plans for ICD transition.
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