National ICD-10 Transition FAQs

Please click here for National ICD-10 FAQs 

Saint Francis ICD-10 Transition FAQs

  • 2/26: Can you make available the presentation on Saint Francis ICD-10 Transition from the January 2014 Organizational Nuts and Bolts Forum?

    Please click here.  
  • 2/6: Will in-house training be provided for employees with a CPC in preparation for taking the ICD-10 certification exam?

    Employees with a CPC who have ICD-9 coding as part of their job description should discuss training options with their immediate manager.

  • 1/30: Which types of practices must make the transition?

    All entities covered by HIPAA must move to ICD-10. Even if your practice doesn't deal with Medicare claims, you will still need to convert to the new codes.

  • 1/29: Where to find the code sets?

    Fortunately, you don't have to purchase a book to obtain the ICD-10 code sets. They are available online, free of charge, at www.cms.gov/ICD10.

  • 1/28: What to consider when budgeting?

    You'll need to account for software upgrades and licensing costs, hardware procurement, staff training costs, revision of forms, workflow changes during and after implementation and risk mitigation.

  • 1/27: How much time to allocate to coder training?

    Physician practice coders need to learn ICD-10 diagnosis coding, which AHIMA estimates should take 16 hours.

  • 1/26: When to schedule training?

    Training should occur between three and six months before the Oct. 1 compliance deadline so that coders can retain the content.

  • 1/25: What to consider outside of coding proficiency?

    The coder should be prepared for the advanced specificity and clinical knowledge requirements of ICD-10, according to AAPC. Those without a strong understanding of, or experience in anatomy and physiology should consider a refresher course.

  • 1/24: When to submit new codes?

    It's great to be fully prepared but CMS and other payers will not be able to process claims using ICD-10 until Oct. 1.

  • 1/23: What will happen to transactions close to the compliance date?

    The date of service will determine the compliant code format to be used. If a service is performed prior to Oct. 1, you'll submit claims with ICD-9 codes. Likewise, you'll use ICD-10 for services performed on or after Oct. 1.

  • 1/22: What will happen if transactions span the compliance date?

    Many payers will require that you split the claims. That means you'll have to submit separate bills; you'll use ICD-9 codes for the services provided prior to Oct. 1, and ICD-10 for services provided on or after Oct. 1.

  • 1/21: What to do now to make sure ICD-10 systems are working properly?

    Plan to test claims, eligibility verification, quality reporting, and other transactions and processes that involve ICD-10 codes. It's important to test beginning to end — from within your practice to outside payers and business partners. Click here for small and mid-size practice time-lines and check-lists.

  • 1/20: Why the change to ICD version 10 (ICD-10)?

    On January 16, 2009, the U.S. Department of Health and Human Services (“HHS”) published the final rules for the modifications to the Health Insurance Portability and Accountability Act (“HIPAA”) electronic transactions and codes set standards?

    Modifications to the HIPAA code set standards includes the implementation of ICD-10 CM diagnosis for institutional and professional services as well as the ICD-10 PCS procedures for institutional procedures effective for services performed on or after October 1, 2014.

    • The current ICD-9 codes lack specificity and scalability.
    • World Health Organization (WHO) is already using ICD-10 for global reporting of disease.
    • ICD-10 provides a better standard for Health Information Exchange (HIE).
  • 1/19: Are there any benefits to the new coding system?

    With the greater level of specificity and clinical detail, improvements and advances in medical technology, terminology and classification of diseases have been updated to be consistent with current clinical practice

    • Measuring the quality, safety, and efficacy of care
    • More accurate payment for procedures
    • Enhancing disease management
    • Facilitation of computer-assisted coding systems
    • Improved clinical documentation
    • Greater flexibility for expansion of new codes
    • Preventing and detecting healthcare fraud and abuse
  • 1/18: Who is affected?

    Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. (The change to ICD-10 does not affect CPT coding for outpatient procedures.) Health care providers, Payers, Clearinghouses and Billing services must use ICD-10 diagnosis codes for all health care services provided in the U.S. on or after October 1, 2014. ICD-10 procedure codes must be used for all hospital inpatient procedures performed on or after October 1, 2014. Claims with ICD-9 codes for services provided on or after October 1, 2014, cannot be paid.

  • 1/17: How will ICD-10 impact the physician’s office?

    On October 1, 2014, the implementation of ICD-10 will impact many aspects of a provider’s practice from the front desk to the provider’s documentation to the paid claims. Key areas that will be affected but not limited to the list below:

    • Computer systems (i.e. EMR and billing systems)
    • Precertification and referrals
    • Diagnostic and laboratory orders will require more specific diagnosis coding
    • Policies, procedures and forms that currently have ICD-9 codes on them
    • Any forms that currently have ICD-9 codes on them (i.e. superbills)
    • Training of employees from the front desk personnel to providers to the back office personnel
    • Clinical documentation will have to be more specific
    • Staff Productivity- will likely decrease during the training phase as well as the initial implementation of ICD-10
    • Revenue- Claims may get denied if not coded properly with ICD- 10
  • 1/16: For physician billing, will ICD-10 replace CPT?

    No. ICD-10-PCS will be used to report facility billing only. The CPT codes and HCPCS codes will continue to be used to report services and procedures in outpatient and office settings.

  • 1/15: What type of training do I need?

    Depending on the employee’s role in this process, the training will vary. Some may only need a basic knowledge of the ICD-10 coding system, while others, such as providers and coders will need specialized training. There will be several different educational mechanisms available within the Saint Francis Hospital and Medical Center system.

  • 1/14: For Providers, What will I need to include in my documentation?

    The level of detail in your clinical documentation will be greater than before. If your documentation is not specific, then the code assigned will be not specific. Payers may not reimburse for unspecified or not listed diagnosis codes which will result in unpaid claims. The type of additional documentation needed will depend on the types of patient visit. There are many variables such as laterality, acute vs. chronic, location that may need to be considered in order to assign the appropriate ICD-10 diagnosis code. All of these factors must be documented in order to accurately code the entire claim. These are not all of the necessary factors, however, different patient visits will require different types of documentation.

  • 1/13: Will the EMR/EHR pick the codes for me?

    Ultimately, it is the provider’s responsibility to select the diagnosis codes for the encounter. The EMR/EHR system you use may direct you to suggested diagnosis codes based on your documentation. Coders and providers should not rely on this list completely. The list should be review and if deemed necessary the code selected by the EMR/EHR should be changed to accurately reflect the clinical encounter documentation.