Health Care Providers Should Prepare Now for the Version 5010/ICD-10 Transition

Will You Be Ready?

Are you prepared for the U.S. health care system’s change from ICD-9 to ICD-10 diagnosis and procedure codes? The switch to ICD-10 takes effect on October 1, 2013. Leading up to the October 1, 2013, compliance date, there are other important dates:

  • Beginning January 2011, providers should begin testing Version 5010 transaction standards with their trading partners
  • January 1, 2012, the date for Version 5010 compliance  

Prepare now to avoid potential reimbursement delays. If you do not use Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards starting January 1, 2012, and ICD-10 codes when submitting claims with dates of service on or after October 1, 2013, your claims may not be paid.

What’s Changing and Who Is Affected? 
Unlike ICD-9 codes, ICD-10 diagnosis codes are alphanumeric, have 3 to 7 digits, and are much more descriptive. ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by HIPAA, not just those who submit Medicare claims. This change does not affect Current Procedural Terminology (CPT) coding for outpatient procedures.

In addition to the code set changes, standards for electronic administrative transactions (such as eligibility inquiries and remittance advices) are being updated from the current Version 4010/4010A1 to Version 5010 on January 1, 2012. Version 5010 accommodates both the ICD-9 and the ICD-10 code set structures. To allow adequate time to meet the January 2012 implementation date, providers should begin testing Version 5010 with their trading partners starting in January 2011.  Providers who use practice management software, a clearinghouse, third-party biller, or some other way to transmit information between themselves and a health care plan, will need to upgrade their software or work with a clearinghouse or billing service whose systems can accommodate both the Version 5010 standards and the ICD-10 code sets.   

Preparing for the Version 5010/ICD-10 Transition 
Start with a gap analysis to determine the impact on your organization of both Version 5010 and ICD-10. Use that information to develop an implementation plan, with a detailed timeline, and estimate of costs. Providers should take the following steps now:

  • Check with your billing service, clearinghouse, or practice management software vendor. Your third-party biller and clearinghouse need to make sure that you will be compliant by the deadlines. Software vendors should be developing and testing products that will enable Version 5010 testing with your payers and billing services starting January 2011.  Testing with ICD-10 should start sometime after Version 5010 implementation in January 2012, to allow for full ICD-10 implementation on October 1, 2013.
  • Start planning to implement the ICD-10 transition. Meet with your professional and support staff. Discuss where codes are used within your organization to help you assess impact. Assign roles and responsibilities for addressing the transition.
  • Identify needs and resources. Consider changes that might be required. Develop a budget and timeline that take into account specific workflow needs, vendor readiness, and staff knowledge and training.

Version 5010/ICD-10 Resources 
There are many professional, clinical, and trade associations offering a wide variety of Version 5010 and ICD-10 information, educational resources, and checklists. Check the Web sites of your associations and other industry groups, or call them, to see what resources are available. 

The Centers for Medicare & Medicaid Services (CMS) Web site, 
www.cms.gov/ICD10/, has official CMS resources to help you prepare for Version 5010 and ICD-10.  CMS will continue to add new tools and information to the site throughout the course of the transition.

Transition Date for Version 5010/ICD-10 

  • January 2011: Version 5010 testing starts across the health care system. Medicare begins accepting Version 5010 electronic claims.
  • January 1, 2012: All electronic claims must be submitted using Version 5010.
  • October 1, 2013: You must submit claims with ICD-10 codes only for services provided on or after this date.