On October 1, 2014, the 30 year old ICD-9 code sets used to report medical diagnosis and inpatient procedures will be replaced by a new ICD-10 code set. So if you're ever burned due to your water skis being on fire, we've got a code for you. Seriously. It's ICD-10 code-V9107XA.
If you are involved in health care, chances are you have heard about the ICD-10 transition. This change affects clinics, facilities, health plans, and anyone covered by the Health Insurance Portability Accountability Act (HIPAA). The transition to ICD-10 is occurring because ICD-9 produces limited data about patient’s medical conditions and hospital inpatient procedures. ICD-9 uses outdated terms and is inconsistent with current medical practice. In addition, the structure of ICD-9 limits the number of new codes that can be created and many ICD-9 categories are full.
Even if you're not already in the middle of an ICD-10 implementation, there are a few things you can be doing now to get ready for the October 14 deadline:
You should also note that not every Health Plan will begin accepting ICD-10 codes at the same time. Some Health Plans will accept them as early as January 2014 (for services after 9-30-14) while others will not accept any ICD-10 codes until October 1, 2014. This may cause confusion with providers trying to get prior authorizations that span the transition date. Therefore, it is imperative that communication with providers and vendors start early and remain constant regardless of the date your Health Plan has chosen to accept ICD-10 codes.
If your health plan receives prior authorization requests that span a year or longer, be sure to think through how you may need to limit your system. Most health plans will receive authorization requests in which the date of service is beyond the 9-30-14 cut-off date for ICD-9 codes long before the system is ready to accept ICD-10 codes. A system limit may be needed because letters are not ready or the system configuration is not complete. And remember, most providers are not equipped to give ICD-10 codes because they, too, are working on being compliant. Here are some things you should consider:
When you have completed your transition, you may feel like you have been bitten by an Orca, initial encounter (ICD-10 code-W5621XA), struck by a macaw (ICD-10 code-W6112XA), or even hurt walking into a lamppost (ICD-10 code-W2202XA) but you will have the satisfaction of a job well done.