ICD-10 Implementation Guidance

After years of speculation and planning the United States is scheduled to transition from ICD-9-CM to ICD-10-CM on October 1, 2013. As with any project of this magnitude, the scheduled implementation date could be moved forward, though the professional staff at PMI believes that there is a high probability that any delays in this process would be of a short duration. However, it is clear the actual work to successfully transition to the new system must begin well before the full implementation date.

ICD-10-CM is a far superior system to ICD-9-CM. Developed by the World Health Organization in 1993, it has already been adopted nearly worldwide. Actual unique codes increase from around 15,000 to more than 68,000. This allows for a considerably higher degree of specificity and facilitates huge gains in communication, tracking and outcome studies.

A key component along the way is the transition from the 4010A1 Transaction Code Set to the new 5010 Transaction Code Set. The current code set cannot support the scope of ICD-10-CM. The targeted implementation for the 5010 Code Set is January 2012. However, the full year of 2011 will be used as a transition year as both 4010A1 and 5010 code sets will be accepted by Medicare. 4010A1 will terminate on January 1, 2012. The crossover to ICD-10-CM is scheduled to take place October 1, 2013.

ICD-10-CM planning in the private practice setting can be divided into two camps, coders and management.

ICD-10 Transition for Coders and Third Party Billers

Actual use of ICD-10-CM codes by coders will not begin until 2013. PMI currently estimates that a certified coder will need three classroom days of instruction to augment their existing skill set. However, this intensive level of training should not be undertaken until the actual year of ICD-10-CM implementation. There is no point in learning systematic information that you can't put to use, and therefore would probably lose.

All PMI Certified professionals are encouraged to participate in continuing education on ICD-10-CM but will not be required to take a course. Certified Medical Coders (CMC) and Certified Medical Insurance Specialist (CMIS) credentialed professionals will be required to pass a one-hour on-line multiple choice exam within the first twelve months of the actual CMS date of implementation.

PMI has already begun conducting overview ICD-10-CM programming in a variety of formats. Beginning October 2010 PMI's Total Access will offer monthly 90 minute overviews by specialty to bring you date appropriate information as it unfolds.

ICD-10 Transition for Managers

The transition for managers is different than coders. Planning and system upgrades should already be underway. Below is a CMS timeline outlining key dates.

ICD-10 and Version 5010 Compliance Timelines

Everyone affected by the Version 5010 and ICD-10 transitions - health care providers, payers, software vendors, and clearinghouses/third-party billers - needs to prepare to meet the following timetable to ensure compliance.