Are you ready for the new HIPAA 5010 Requirements and ICD-10 Coding standards that are quickly approaching?
For those of you that who handle medical claims, you are probably aware of the many changes that we will soon be facing in the medical billing industry. With the first deadline of January 1, 2012 right around the corner, it is imperative that you are prepared for the new HIPAA 5010 requirements. If you are not aware of what I am referring to, please let me explain – In the near future, a federal mandate is going to require that clearinghouses, billing vendors, health plans and health care providers use a new set of coding standards in regards to electronic transactions. These transactions will include claim submission, remittance, eligibility, and claim status.
So what does this mean for you and your practice?
I highly suggest that you start by contacting your clearinghouse and billing software company to confirm that they are preparing for this change. It is also important to find out if it is going to be necessary for you to upgrade your software and if you will be required to submit claims for testing.
What is the purpose of this upgrade?
The ultimate reason for this upgrade is to prepare for the MASSIVE change in the billing process that is going to occur on October 1, 2013. I know that this seems like it is a distant date but I highly encourage you to do your research in order to fully grasp the extent of this change and understand why it is important to start preparing now.
The standard ICD-9 codes that have been used for over 30+ years by physicians, physical therapist, and other healthcare providers will soon become obsolete. The new ICD-10 coding system is not an upgrade but rather a 100% replacement for what has been used for decades.
To help you better understand; below are a few key points about what the new ICD-10 codes will look like:
a.) ICD-10 codes will consist of 3-7 characters
b.) ICD-10 will consist of 21 chapters
c.) ICD-10 will all begin with an alpha prefix
d.) ICD-10 will contain 5 times the amount of codes that ICD-9 codes did
e.) ICD-10 codes will show laterality (which side of the body)
f.) 8 Chapters of the ICD-10 codes will REQUIRE a 7th digit
g.) ICD-10 codes will consist of category, etiology, anatomic site, severity, extension
h.) ICD-10 codes will consist of placeholders “x”, that will hold positions for future expansion
In order to demonstrate just how complex and detailed the new ICD-10 coding will be in comparison to the current coding system, I have included an example of how to build a full code under the new regulations below:
S52. - Fracture of Forearm
S52.5 – Fracture of lower end of radius
S52.52 – Torus Fracture of lower end of radius
S52.521 – Torus Fracture of lower end of right radius
S52.521A – Torus Fracture of lower end of right radius, initial encounter
As you can imagine, this coding overhaul is going to result in extensive training in order to get medical providers and billing coders up to speed on the new ICD-10 system. Although October 1, 2013 is over two years away, I believe that the severity of this change is so great that it is important to start educating and training now in order for you to be fully prepared for the ICD-10 standards.