General Information on ICD-10
International Classification of Disease (ICD) is a standard set of diagnosis and procedure codes used to:
- Identify symptoms, conditions, problems, complaints or other reasons for medical services or procedures being provided.
- Translate written information in a patient's chart into a form that can be submitted electronically for reimbursement.
- Identify provided procedures and services.
- Establish current world mortality code for death records.
The federal government mandated implementation of the new ICD-10 code set for services provided on and after October 1, 2014. The new code set provides more detail in diagnosis and hospital procedure codes used by doctors, hospitals, and insurers.
CMS has announced a plan to implement the new CMS-1500 form — the form used for billing professional services — (version 02/12) beginning Jan. 6, 2014. Starting Apr. 1, 2014, CMS and Wellmark will accept only the revised version of the form.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note: the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
Testing with Wellmark
Wellmark plans to begin testing for ICD-10 in collaboration with providers beginning April 1, 2014. Testers can submit electronic test claims only, containing ICD-10 codes to receive an 835 remittance advice notice. Billing edits and grouper software specific to ICD-10 will be used to process electronic test claims and determine reimbursement.
If a clearinghouse or billing entity is utilized to submit claims on behalf of your provider entity, you will need to coordinate with them: the creation and submission of test claims (837)- along with receipt of test remittance advices (835). It is important to ensure the support you need is available throughout testing and that you are utilizing the same submission method for business as usual. It is necessary that you collaborate with your vendor or clearinghouse, rather than assuming their responsibility for testing readiness.
Valid production data will be required on test claims, such as provider and member detail, in order to process test claims. Test data cannot be masked. Wellmark suggests converting a variety of recently submitted claims to ICD-10 and submitting for testing. All electronic test claims must be clean and process first pass; test claims will not be manually worked in the test environment. Additional information regarding ICD-10 testing will be available on Wellmark.com no later than March 17, 2014.
Benefits of ICD-10
The new ICD-10 system will more accurately reflect technology and medical treatment, improving your ability to:
- Measure health care outcomes.
- Enhance clinical decision-making.
- Track public health issues.
- Conduct medical research.
- Identify fraud and abuse.
- Appropriately pay for services provided.
Wellmark’s Plans for ICD-10 Regulatory Conversion
In 2011, Wellmark assessed its systems, business processes, policies, and communication needs associated with the impacts of the ICD-10 conversion. Throughout 2012-2014, Wellmark will update all systems and processes to use ICD-10 codes to meet the compliance timeframes.
ICD-10 Frequently Asked Questions
Wellmark will add information to this FAQ regularly, so check back often.
ICD-10 Education and Training Resources
- Additional resources are available on the following sites: