Preparing for ICD-10 & HIPAA Transaction Code Set 5010

July 06, 2010

Though Oct. 1, 2013, the implementation date for ICD-10, may seem a long way in the future, there are some actions that you should be taking now to ensure that you will be ready on time.

Upgrade to 5010

To submit Medicare/Medicaid claims using ICD-10, your billing software must be upgraded to the 5010 transaction set. Once your vendor has completed the upgrade, you can begin testing the system starting Jan. 1, 2011. If you use a clearing house to submit claims, make sure they will be ready to accept the new format in time for testing.

Do not wait until the last minute to test, as there may be some system glitches that must be fixed before the go-live date. Successful testing must be completed by Jan. 1, 2012, when 5010 will be fully implemented. You will not be permitted to submit claims using 5010 unless you have completed the testing process prior to Jan. 1, 2012. Medicare will not accept claims submitted on the 4010 set after Dec. 31, 2011.

Transition to ICD-10

Once your system has successfully completed the upgrade to 5010, you can begin submitting claims using ICD-10 diagnosis codes. To prepare for the transition, the practice should review a sample of clinical documentation for both visits and procedures from all providers to ensure that the indications, symptoms and findings meet the specification requirements for ICD-10. If not, educate your providers to be as specific as possible in their documentation. Educate your billing staff on the use of ICD-10 several months before the implementation date.

In addition, all charge capture documents and electronic systems must be revised to include the most frequently used ICD-10 codes. Private payors may have a different timeline for transition to ICD-10 than the federal plans. Be sure to contact them to get their implementation dates.

There may be a significant cost to the practice for the 5010 upgrade and ICD-10 implementation. Be sure to budget for the additional expense.

Information on the implementation of 5010 and crosswalks from ICD-9 to ICD-10 can be found at the following Web sites:

McVey Associates, the firm that provides AGA-endorsed coding and billing seminars, is planning extensive training programs throughout the country to educate physicians and staff on the transition to ICD-10. Information on the sessions will be available on the AGA Web site as the implementation date approaches.

Transition Time Line

Action  Date
Contact vendors, clearinghouses and payors Now
Testing period for 5010  Jan. 1–Dec. 31, 2011
Go live for 5010  Jan.1, 2012
Review documentation for specificity Jan. 1–June 30, 2013
Change all charge capture documents July 1, 2013
Upgrade electronic record to accept ICD-10  Before July 1, 2013
Train physicians and staff on ICD-10  July/August 2013
Start submitting ICD-10 claims No later than Sept. 1, 2013
Go live for ICD-10  Oct. 1, 2013

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