Optometry Coding & Billing Alert

You cant submit ICD-10 codes without this new form, starting in 2012.

If you thought ICD-10 was a distant dream, its time to snap back to reality: CMS is prepping for ICD-10 -- and you should, too. Youll have to get used to a new HIPAA 5010 form (which replaces the 4010 form) as a prerequisite to submitting ICD-10 codes, CMS says in MLN Matters article SE0904, issued on May 5.

Timeline: CMS advises practices that they must be ready to submit claims electronically using the X12 version 5010 effective Jan. 1, 2012.

CMS published the final rule for implementing the 5010 transaction standard on Jan. 15, and the new MLN Matters article lays out some of the crucial details you need to know to get ready.

The big news regarding the 5010 is that it will allow you to report your ICD-10 codes (ICD-10 will take effect on Oct. 1, 2013). However, the new HIPAA 5010 form has other uses as well.

For example: The new form distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes, the MLN Matters article notes.

CMS hopes to use this data to monitor mortality rates for some illnesses, outcomes for specific treatment options, and hospital stay durations for some conditions.

Plus: The new form offers an indicator on institutional claims for present on admission conditions.

Get Granular Specificity With ICD-10

ICD-10 contains more than 155,000 diagnosis codes, almost ten times as many as are in ICD-9. CMS hopes that this will allow optometrists to describe conditions more specifically and in greater detail.

A 2008 CMS MLN Matters article (SE0832) states, Compared to the current ICD-9 classification system, ICD-10 offers more detailed information and the ability to expand specificity and clinical information in order to capture advancements in clinical medicine. Providers may want to become familiar with the new coding system.

Example: In the United States, there is only one ICD-9 code for senile incipient cataract: 366.12 (Incipient cataract). ICD-9 provides no more detailed diagnosis coding beyond that point.

ICD-10, however, provides the following diagnoses under age-related incipient cataract (H25.0):

" H25.01 -- Cortical age-related cataract

" H25.011-- Cortical age-related cataract, right eye

" H25.012 -- Cortical age-related cataract, left eye

" H25.013 -- Cortical age-related cataract, bilateral

" H25.019-- Cortical age-related cataract, unspecified eye

" H25.03 -- Anterior subcapsular polar age-related cataract

" H25.031 -- Anterior subcapsular polar age-related cataract, right eye

" H25.032 -- Anterior subcapsular polar age-related cataract, left eye

" H25.033 -- Anterior subcapsular polar age-related cataract, bilateral

" H25.039 -- Anterior subcapsular polar age-related cataract, unspecified eye

" H25.04 -- Posterior subcapsular polar age-related cataract

" H25.041 -- Posterior subcapsular polar age-related cataract, right eye

" H25.042 -- Posterior subcapsular polar age-related cataract, left eye

" H25.043 -- Posterior subcapsular polar age-related cataract, bilateral

" H25.049 -- Posterior subcapsular polar age-related cataract, unspecified eye

" H25.09 -- Other age-related incipient cataract.

Prepare Your HIPAA Plans Now

Bottom line: If CMS is announcing the HIPAA 5010 transition information now, chances are the agency is trying to get you to start planning before its too late.

Key: Its imperative that you ask your software vendors whether your billing systems are HIPAA 5010-ready.

This will be bigger than the Y2K changes, says Barbara J. Cobuzzi, MBA, CPC,CPC-H,CPC-P, CENTC, CHCC, senior coder and auditor for The Coding Network and president of CRN Healthcare Solutions.

To read the MLN Matters article, visit www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf.

Get help: On June 9, 2009, CMS is hosting a national provider education conference call on HIPAA 5010. The call will give a general overview of the transition and address some of the exceptions and situations you may encounter as the new version is implemented, according to a CMS release. You can register for the call at  www2.eventsvc.com/palmettogba/060909. To view a PowerPoint presentation on HIPAA 5010, visit www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp.