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Frequently Asked Questions
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What is ICD-10?
International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the World Health Organization (WHO). It replaces the International Classification of Diseases, 9th Revision (ICD-9) that was developed in the 1970s.
The codes are the foundation for documenting the patient’s state of health and the institutional procedures provided.
Included in the ICD-10 are:
- ICD-10 CM (Clinical Modification) clinical modification of WHO standards for diagnosis
- ICD-10 PCS (Inpatient Procedures) inpatient procedures developed and maintained by CMS (Center for Medicare and Medicaid Services).
Why are we switching to ICD-10?
ICD-10 (CM and PCS) is a complete revision of its ICD-9 counterpart. ICD-10 improves clinical communication by providing more information per code and better support for care management, quality measurement and analytics. It also offers an improved ability to understand risk and severity.
Who must comply with ICD-10?
Per the US Department of Health and Human Services (HHS), all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must switch to ICD-10.
When are we switching to ICD-10?
The ICD-10 compliance date is October 1, 2015.
What are some of the differences between ICD-9 and ICD-10?
There are several key differences between ICD-9 and ICD-10 including:
- The code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. (ICD-10 codes use alphanumeric characters in all positions, not just the first position, as in ICD-9.)
- ICD-10 allows for increased specificity, allowing more information to be conveyed in a code.
- ICD-10 terminology is more modern and consistent throughout the code set.
- ICD-10 codes are a combination of diagnoses and symptoms, so fewer codes need to be reported to completely describe a condition.
- Enhanced ICD-10 codes enable reporting of laterality (right vs. left) to designate which side of the body or limb is being evaluated.
- In reporting of obstetric diagnosis, the ICD-10 codes classify the patient by their trimester of pregnancy (not their episode of care).
What is Johns Hopkins HealthCare (JHHC) doing to educate providers about ICD-10?
An ICD-10 Provider Seminar is planned for August 2015. Providers will have a chance to ask questions and speak with an expert about how ICD-10 will impact the health care industry and doing business with JHHC. Information about the upcoming seminar will be posted on the JHHC website at www.jhhc.com.
What should providers do to prepare for the transition to ICD-10?
Providers should test their ICD-10 systems early to ensure compliance. Visit the CMS website at www.cms.gov/ICD10 to view the CMS timeline and implementation handbooks.
Is JHHC prepared to meet the ICD-10 deadline of October 1, 2015?
Yes. JHHC has completed a full ICD-10 Impact Assessment and is committed to successfully meeting implementation standards and deadlines.
Will JHHC accept ICD-10 codes before the implementation date?
No. ICD-10 codes will not be accepted before the implementation date of October 1, 2015. Please note that claims with dates of services before the implementation date must use ICD-9 codes.
Will JHHC deny physician or other practitioner claims billed under Part B based on specificity of ICD-10 diagnosis code as long as the code is from the same family?
ICD-10 is required 10/1/15, however, we are not denying for specificity, as long as ICD-10 code is valid and in the appropriate family of codes, JHHC will accept it.
How should claims be processed when they are split for an outpatient encounter spanning the ICD-10 implementation date? (The outpatient encounter begins on or before September 30, 2015 and ends on or after October 1, 2015).
Per CMS, outpatient claims for services provided prior to October 1, 2015, must be billed separately from services provided on or after October 1, 2015. When claims are split for an encounter spanning the ICD-10 implementation date, you must maintain all charges with the same Line Item Date of Service (LIDOS) on the correct corresponding claim for the encounter.
Do not split single item services whose timeframes cross over midnight on September 30, 2015, into two separate charges. Instead, place the single item service in the claim based upon the LIDOS as follows:
- Emergency room (ER) encounters – Date the patient enters the ER
- Observation encounters – Date observation care begins.
For more information about split claims, visit www.cms.gov/ICD10.
How should claims be processed when they are split for an inpatient encounter spanning the ICD-10 implementation dates? (The inpatient encounter begins on or before September 30, 2015 and ends on or after October 1, 2015).
Per CMS, the patient discharge date will determine the correct ICD code to place on the claim. ICD-9 codes should remain on claims with dates of service through September 30, 2015. ICD-10 codes should be placed on claims with dates of service beginning October 1, 2015 and later. For more information about split claims visit www.cms.gov/ICD10.
Is JHHC making changes to its current claims timelines in anticipation of ICD-10?
No, there are no planned changes to claims timelines.
How is JHHC updating claims and algorithms? Will changes be communicated to providers?
At this time, we are not planning to make any changes to claims or algorithms.
Is JHHC implementing new claims status or rejection error codes?
No, we are not implementing new claims status or rejection codes.
Will JHHC allow ICD-9 and ICD-10 coded claims in the same file for production?
Yes. ICD-9 and ICD-10 codes claims will be allowed in the same file for production.
Will JHHC return 835s for providers to review results?
This is a decision each provider makes. JHHC will comply with individual provider requests.
Will JHHC require providers, clearinghouses, etc. to be certified in order to send ICD-10 claims?
If we already accept 5010 compliant files, certification is not necessary. If we do not accept 5010 compliant files, please contact your Network Manager for specific details.
How will JHHC handle ICD-9 codes after October 1, 2015?
JHHC will accept ICD-9 codes with dates of service prior to October 1, 2015, both electronically and on paper.
Does JHHC expect delays in reimbursement/adjudication for ICD-9 claims processing in the period after ICD-10 implementation (after October 1, 2015)?
No delays are expected.
What types of reimbursement changes are anticipated from the ICD-10 conversion?
ICD-10 is not anticipated or intended to create any change to reimbursement rates.
Does JHHC plan to relax timely filing periods and appeal periods?
No changes to the filing standards are planned.
Is JHHC updating Medical Policies? If so, when would that be completed?
Yes. The Medical Policies will be updated prior to ICD-10 implementation.
Does JHHC have an ICD-10 provider liaison?
If you have specific questions about your ICD-10 transition, please contact your network manager. You can also contact the Provider Relations department at 888-895-4998 or 410-762-5385. General ICD-10 information can be found at www.cms.gov/ICD10.
Where can I get more information about ICD-10?
Additional ICD-10 information can be found on the following websites:
- Center for Medicare & Medicaid Services (CMS) – www.cms.gov
- American Medical Association (AMA) – www.ama-assn.org
- American Health Information Management Association (AHIMA) – www.ahima.org
- American Academy of Professional Coding – www.aapc.com
- Maryland Department of Health and Mental Hygiene – http://dhmh.maryland.gov/SitePages/Home.aspx
- Johns Hopkins HealthCare – www.jhhc.com