Latest Update 09/04/2012

Health and Human Services (HHS) Secretary Kathleen Sebelius announced a final rule that will save time and money for physicians and other health care providers by establishing a unique health plan identifier (HPID). The rule is one of a series of changes required by the Affordable Care Act to cut red tape in the health care system and will save up to $6 billion over ten years.

The rule also makes final a one-year proposed delay – from October 1, 2013, to October 1, 2014 – in the compliance date for use of new codes that classify diseases and health problems.

These code sets, known as the International Classification of Diseases, 10^th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.

More information on the final rule is available in a fact sheet, dated 8/24/12, at http://www.cms.gov/apps/media/fact_sheets.asp. 

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. In 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. Targeted provider testing is projected to begin in the early third 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 FAQ 

ICD-10 Education and Training

Any business process or technology that stores, processes, or utilizes medical/diagnosis/procedure codes is affected on some level. Learn more about ICD-10 by viewing additional online resources at http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10 .

Additional ICD-10 Resources

Look for additional resources on the following sites:

• American Health Information Management Association 
• Centers for Medicare & Medicaid Services 
• Centers for Disease Control and Prevention (CDC) 
• American Medical Association