Latest Update 11/6/2013
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new diagnoses and surgical procedures that improve the quality of information available for quality improvement and payment purposes.
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. Wellmark will follow CMS implementation. Please note: if the new version is received prior to Jan. 6, 2014, Wellmark will return the claim to the provider along with a letter advising of when we will begin accepting the new claim form. Starting Apr. 1, 2014, CMS and Wellmark will accept only the revised version of the form.
NOTE: the HIPAA 5010 837 electronic claims forms will remain the same; however, if your facility uses a clearinghouse or billing service to submit medical claims to Wellmark, you will need to work with your billing service to coordinate all of your ICD-10 testing needs.
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.
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.
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.
Wellmark’s plan is being integrated with key business partners, including vendors and clearinghouses. Periodic updates will be shared with the provider community and other stakeholders. Provider testing is projected to begin early second quarter of 2014.
ICD-10 Frequently Asked Questions
Here are some frequently asked questions regarding Wellmark’s plans and progress to ICD-10. Wellmark will add information to this Q&A regularly, so check here often.
ICD-10 Education and Training
Additional ICD-10 Resources
Look for additional resources on the following sites: