We are committed to keeping you informed about ICD-10 updates through our provider newsletter and other communications. This section of our website is intended to provide the most current information and resources available related to ICD-10.
The current Center of Medicare & Medicaid Services (CMS) ICD-10 compliance date is October 1, 2015. As of October 1, we will be ready to accept ICD-10 codes on claims based on dates of service (outpatient) or dates of discharge (inpatient). The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
Providers will be required to submit Health Insurance Portability and Accountability Act (HIPAA)-compliant transactions in version 5010. As of October 1, all HIPAA-covered entities must use the new ICD-10 code sets.
The current ICD-9 code sets are out-of-date due to their limited ability to accommodate new procedures and diagnoses. ICD-10 incorporates greater specificity of codes - more clinical information contained in the codes - and updated terminology.
Use of ICD-10 will:
Improve the ability to measure health care services
Enhance the ability to monitor the populations' health
Provide better overall data and decrease the need for supporting documentation needed when submitting claims
What is ICD-10?
Effective October 1, 2015, all health care entities must use ICD-10 codes on HIPAA transactions, including:
Diagnosis codes (ICD-10-CM) used by all providers in every health care setting
Procedure codes (ICD-10-PCS) only used for hospital claims and inpatient hospital procedures
What are the effective dates?
After October 1, 2015, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the October 1 compliance date.
What is different?
ICD-10 codes length and structure differ from ICD-9 codes. In addition, ICD-10 codes:
Contain more detail about conditions, injuries and illnesses
Include the concept of laterality
Use combination codes to describe conditions and associated symptoms
Use updated language and terminology
How do I prepare?
Learn about the structure and differences of the ICD-10 code set
Look at your organization and see what it will take to make the change
Train coders on ICD-10 prior to October 1, 2015 Talk with your vendors, payers, clearinghouses, billing services about ICD-10 readiness
If you have not already started to prepare it is important that you start now!
What is our health plan’s position on ICD-10 implementation?
We have remediated all of our systems to be ICD-10 compliant. ICD-10 testing with our providers is underway and will continue through the beginning of September 2015.
If you are interested in testing with our health plan, please email your practice contact information to ICD-10.Test.Team.Communications@excellus.com and you will be contacted via email with updates. Please do not include any other confidential information in this email request.