What you need to know about the latest ICD-10 rule

Late Thursday, July 31, the Department of Health and Human Services (HHS) issued a press release confirming the new Oct. 1, 2015, deadline for clinicians, health plans, and clearinghouses to transition to ICD-10. It was no surprise to the industry.

That date had widely been anticipated since the U.S. Congress passed “doc fix” legislation in March, which also forced yet another delay of ICD-10 adoption. The July 31 HHS press release stated that “This deadline allows providers, insurance companies and others in the healthcare industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.”

Anecdotal information gathered by Behavioral Healthcare in July from IT vendors in the behavioral healthcare space indicates that most vendors are in the testing phase for the new code sets and anticipate readiness in plenty of time.

According to HHS, ICD-10 codes will provide better support for patient care and care coordination.

FACT FILE: 10 facts about ICD-10

1.       The World Health Organization updated the International Classification of Diseases (ICD) code set in 1990, and other countries began adoption in 1994.

2.       The Centers for Medicare and Medicaid Services (CMS) originally set the ICD-10 implementation date for the United States on October 1, 2013. Adoption has been delayed twice, now set for October 1, 2015.

3.       ICD-10-CM has 68,000 codes of three to seven characters each; while ICD-9-CM has 13,000 codes at three to five characters.

4.       The transition to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.

5.       CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2015, compliance date.

6.       ICD-10 requires far more specificity and details in the documentation to support the diagnosis.

7.       There are no exact crosswalks between code sets.

8.       Transitioning to the ICD-10 code set will require clinical judgment and a little more documentation time.

9.       Generally, payers  still require DSM codes for prior authorizations.

10.   The American Psychiatric Association wants reconciliation between some codes in the DSM manual with the ICD-10 CM as a part of the ICD-10 CM revision process.

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The HHS press release offered additional information about ICD-10 here.