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ICD-10 Diagnosis and Procedure Codes

Oct. 1, 2015, marks the introduction of the International Classification of Diseases, 10th Revision (ICD-10) codes. All providers and health insurers are affected, as well as any business process or technology that stores, processes or uses medical/diagnosis/procedure codes. While the change to ICD-10 does not affect current procedural terminology (CPT) coding for outpatient procedures and physician services, the introduction of the new codes is the most significant change of this kind in 30 years. Wellmark is ready for the transition and is committed to helping providers prepare.

ICD-10 Testing

To ensure a smooth transition to ICD-10, Wellmark strongly recommends all providers test claims submissions through our electronic testing environment. For dates of service of October 1, 2015 and after, claims using ICD-9 codes will be rejected, so providers should begin testing now. Click below to get started.

 

Test Today 

 

Follow these testing instructions now to ensure a positive testing experience.

  Go Electronic 

 

Wellmark only allows testing of electronic claims submissions. If you are not set up to submit claims electronically, please register now.

 

ICD-10 testing with Wellmark is more than simply confirming that you can create electronic claims in the correct format. Rather, it will allow you to exchange and review ICD-10 data on test claims, giving you a clearer understanding regarding whether your claims will process through Wellmark’s business rules and edits as expected after the introduction of the new codes. NOTE: Wellmark does not support the testing of paper claims or those submitted through Wellmark’s online Create & Submit a Claim tool.

Benefits of 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.

ICD-10 offers additional specificity to the current ICD-9 claims reporting process. The increased granularity of choices will help providers define which services were rendered and why.

 

The new ICD-10 codes will more accurately reflect technology and medical treatment, improving your ability to:

  • Measure health care outcomes.
  • Enhance clinical decision-making.
  • Track issues that affect public health.
  • Conduct medical research.
  • Identify fraud and abuse.
  • Appropriately pay for services provided.

ICD-10 will provide more detail to understand each patient's particular needs, illustrate patient trends, and set health care goals. It will also help to advance research, measure quality outcomes, and demonstrate value of care in a way that is not possible with ICD-9.

Key Differences with ICD-9

Even though you will use a similar process to look up ICD-10 codes as you use for ICD-9 codes, there are some differences in the code sets. The following table provides an overview of some important differences in the ICD-9 and ICD-10 code formats:

 

ICD-9ICD-10
Consists of 3 to 5 characters Consists of 3 to 7 characters 
First position is numeric or alpha (E or V); positions 2, 3, 5–6 are numeric First position is alpha. Second position is numeric while positions 5–7 can be alpha or numeric

Education and Training Resources

In addition to testing information and instructions, Wellmark offers two important resources.

 Additional resources are available below.



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