ICD-10 Diagnosis and Procedure Codes
Latest Update 3/25/15
The Department of Health and Human Services has announced the final compliance date for the International Classification of Diseases, 10th Revisions (ICD-10) as October 1, 2015 and Wellmark is committed to meeting all mandate requirements, including the implementation of the ICD-10 code set.
The transition of 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 and 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.
The federal government mandated implementation of the new ICD-10 code set for services provided on and after October 1, 2015. ICD-10 offers additional specificity to the current ICD-9 claims reporting process. The increased granularity of choices will help providers define what and why services were rendered.
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.
ICD-10 will provide more detail to understand each patient's particular needs and illustrate patient trends to progress towards set health care goals. It will also help to advance research, measure quality outcomes, as well as demonstrate value of care in a way that is not possible with ICD-9.
The following table provides the differences between ICD-9 and ICD-10 coding:
|ICD-9 - CM||ICD-10 - CM
|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 s, 5-7 can be alpha or numeric
|Decimal in the fourth position
||Decimal in the fourth position
|Alpha characters are not case sensitive
||Alpha characters are not case sensitive
Wellmark’s Plans for ICD-10 Regulatory Conversion
Wellmark has assessed its systems, business processes, policies, and communication needs associated with the impacts of the ICD-10 conversion. Beginning in 2012, Wellmark updated all systems and processes to accept and utilize ICD-10 codes in order to remain compliant.
Wellmark will be ready to test electronic submission for ICD-10 claims. We encourage all providers to take advantage of this opportunity to ensure proper claim submission and processing after Oct. 1, 2015. Information regarding testing will be forthcoming.
ICD-10 Education and Training Resources
The upgrade to ICD-10 affects every provider, so education and training is very important for your staff. Of course bookkeeping and business personnel will need training, but your accounting system software and hardware may also need upgrading to achieve a seamless switchover.
Each organization has its own needs. For example, coders will need to train for diagnosis changes and should access free resources, such as those offered through the CMS website.
Any business process or technology that stores, processes, or utilizes medical/diagnosis/procedure codes is affected on some level. Get Started Today!
Small-Medium Physician Practices: Build an action plan and start transition to ICD-10. Find out how by visiting the CMS website.
Large Physician Practices and Hospitals: Transition to ICD-10 now with the help of CMS' ICD-10 Implementation Guides.
Additional resources are available on the following sites: