Transition to ICD-10

By Lisa Maresca

On October 1, 2015, a key element of the data foundation of the United States’ health care system will undergo a major transformation. We will transition from the decades-old Ninth Edition of the International Classification of Diseases (ICD-9) set of diagnosis and inpatient procedure codes, to the far more contemporary Tenth edition of those code sets—or ICD-10—used by most developed countries throughout the world.

The transition will have major impact on anyone who uses health care information that contains a diagnosis and/or inpatient procedure code.

ICD-10 FAQs

Q: Will the ICD-10 conversion impact provider reimbursement and contracting?

A: We believe the transition will impact the entire industry. Mappings between ICD-9 and ICD-10 identify corresponding diagnosis codes between the two code sets. It’s important to note that the ICD-10 conversion was not intended to transform payment or reimbursement; however, it may result in reimbursement methodologies that more accurately reflect patient status and care.

Q: Will Lifetime Benefit Solutions support dual intake of codes?

A: We plan to meet all time frames for compliance. We expect providers, vendors and clearinghouses to meet these time frames as well. Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid. We will continue to follow the communications from the regulatory authority and we will adapt our approach as permitted. 

Q: Where is Lifetime Benefit Solutions in the process of ICD-10 implementation?

A: We are moving forward with our implementation plan. This plan includes:

  • Determination of training needs
  • Completion of a communication plan
  • Mapping, remediation and testing activities are under way
  • Selection and installation of a tool to map ICD-9 to ICD-10 codes
  • Completion of a testing plan

Q: What should physician practices and facilities do to prepare for the ICD-10 compliance date?

A: The compliance date is nearing, and the complexity of conversion requires immediate action to address the business and clinical issues associated with the transition. The ICD-10 conversion will affect nearly all provider systems and many processes. The largest impacts will likely be in clinical and financial documentation billing and coding. It is critical not to delay planning and preparation. It is important that providers contact their billing or software vendors to understand plans for conversion and testing.

Q: What is Lifetime Benefit Solutions’ position on the final rules issued for ICD-10 compliance?

A: We plan to meet all applicable time frames for compliance and we will work with providers, software vendors and third-party billing agencies as they strive for compliance. We believe that more detailed coding is helpful and brings the United States in line with non-U.S. practices. ICD-10 codes allow for more accurate information to accompany a claim, which will allow for more accurate claims payment and coverage decisions.

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