1. Q: What is
ICD-10?
A: ICD-10 is the International Classification of Diseases, version 10.
(ICD is the international standard for diagnostic classifications.) The current
version, ICD-9, was adopted in 1979.
2. Q: What changes are occurring in the ICD-10 version?
A: The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure
codes. The changes are as follows:
** The diagnosis codes (ICD-9) are currently three to five digits that are
alphanumeric in nature and combine to make around 14,000 unique diagnosis codes
being used today. For ICD-10, the diagnosis codes will be seven digits that are
alphanumeric in nature and combine to make around 68,000 unique diagnosis codes
** Currently, ICD-9 procedure codes are three to four digits that are numeric
in nature and combine to make about 4,000
unique procedure codes. For ICD-10-PC
S (inpatient), the procedure codes will be 7 alphanumeric in nature and combine
to make around 72,000 unique procedure codes.
3. Q: What is the primary purpose of this change?
A: The primary purpose of the change to ICD-10 is to improve clinical
communication. It allows for the capture of data about signs, symptoms,
risk factors and comorbidities and better describes the clinical issues
overall. It will also enable the United States to exchange information across
country borders.
4. Q: What is CarePlus’ plan for ICD-10 acceptance?
A: CarePlus will accept ICD-9 codes
on claims w/ date of service (DOS),
or discharge dates of September 30, 2014 or prior.
CarePlus will accept ICD-10 codes on claims w/ DOS, or discharge dates of
October 1, 2014 or after.
5. Q: Do you plan to be ready to process ICD-10 codes submitted on
claims forms by Oct 1, 2013?
A: CarePlus will go live with the ICD-10 codes effective October 1, 2014.
6. Q: How long will support for both ICD-9 and ICD-10 coding be
provided?
A: CarePlus will process correctly coded
transactions within the date ranges
specified in the answers above until the volume of ICD-9
submissions is diminished.
7. Q: When will CarePlus begin testing transactions?
8. Q: Do you have a communication plan and schedule for customers to keep
them informed?
A: The ICD-10 Program team is currently working on a communication plan and
schedule with testing partners, trading partners, providers and internal
departments.
9. Q: Will your claims adjudication
processing vary by contract type (e.g.,
hospital, professional provider, and/or ancillary services)?
A: CarePlus does not foresee any issues with claims processing with the change
to ICD-10. Testing will begin in early 2013 to mitigate any such issues.
10. Q: Will CarePlus purchase any new
technology as part of its preparation
for ICD-10 implementation?
A: CarePlus is remediating the systems that are currently in place for claims
reimbursement.
11. Q: Will CarePlus be using GEMS as part of its process, or for creating
files coming in or out?
A: CarePlus will process transactions in its “native” format and will not
be using GEMS to crosswalk ICD-9 codes and ICD-10 codes for inbound or outbound
v5010A1 transactions.
12. Q: Will there be any changes in payment with the change to ICD-10?
A: CarePlus’ plan is to be reimbursement neutral. There should be no change to
the way a claim is paid with ICD-10 and ICD-9
codes unless an MS-DRG change has
taken place or a contract has been
rewritten to incorporate a change of reimbursement.
13. Q: What claim-processing issues does CarePlus anticipate with the
preparation for ICD-10?
A: CarePlus is investing in remediation of systems and processes to
support the ICD-10 requirements. CarePlus does not
foresee any issues with claims processing
with the change to ICD-10, although rejection due
to misuse of new codes is possible. Testing will begin in early 2013 to
mitigate any such issues.
14. Q: What key information should providers to keep in mind as they develop
their own ICD-
10 implementation plans?
A: CarePlus suggests that providers stay
up-to-date on any changes by CMS
regarding the ICD-10 implementation. This can
be done by monitoring the CMS
website. If providers have questions or concerns,
they may contact their CarePlus provider associate.
Websites offering additional information on 5010 and ICD 10 are:
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