Practice Management Alert

Changes are on the horizon, and although 2012 and 2013 seem far off, you'll be scrambling if you don't start preparing now. By Jan. 1, 2012, you'll have to be ready to submit your claims electronically using the new HIPAA 5010 form. Following that change, you'll soon after have to be ready to change from the ICD-9 diagnosis system that you've become accustomed to and start using the new ICD-10 system.

You'll 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 of this year.

The problem: You won't be able to submit ICD-10 codes without this new form, so start preparing. 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 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.

The goal: 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.

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

Key to success: Asking your software vendors whether your billing systems are HIPAA 5010-ready is imperative.

"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.

The biggest change you'll need to cope with when ICD-10 rolls around is sheer numbers. The 2013 edition of the diagnosis coding manual will expand the code set from 17,000 codes, which ICD-9-CM currently has, to over 155,000 codes, which ICD-10 will include. Your resources should currently be expended on training the coder who will be your coding point of contact and on developing a transition plan, said Jeanne Yoder, RHIA, CCS-P, CPC, CPC-I, during the Coding Institute audioconference, "ICD-10 Issues: Get Ready for the Conversion ASAP."

Start preparing now by learning the basics. Here are some of the major differences you can expect out of ICD-10:

• More specificity. ICD-10 greatly expands the level of detail, but don't let that scare you. While the codes can provide greater specificity, assigning them won't necessarily require more detailed documentation. Other initiatives such as pay-for-performance and quality measures may require more detailed documentation. ICD-10 will simply provide the means for reporting that greater detail.

• Newer terminology. ICD-10-CM updates medical terminology and classification of disease to be consistent with current medical practice.

• More characters. Codes in ICD-10-CM are all alphanumeric and can be up to seven characters in length. The seventh character, referred to as an extension, is to show episode of care, such as initial encounter, subsequent encounter, or sequel, and other additional information.

• More combination codes. ICD-10 combination codes provide detail that requires more than one code in ICD-9.

Helpful hint: Once you've become familiar with ICD-10-CM and the way it works and looks, you'll want to get some official training. But don't get your staff trained too far in advance, warns Joanne Byron, LPN, BSNH, CHA, CMC, CPC, CPC-I, MCMC, PCS, CEO of the American Institute of Healthcare Compliance Inc.,

in an email to members. If they can't apply what they've learned, the "use it or lose it" factor will kick in.

Best bet: Wait until three to six months before the final implementation date, experts suggest. Two to three days of training should be adequate for coders already trained with ICD-9 to learn what they need to know to make the transition.

More information: To read the MLN Matters article on HIPAA 5010, visit www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf. To view the ICD-10 codes, visit this site:

www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm. Stay tuned to Medical Office Billing & Collections Alert for more information as the HIPAA 5010 and ICD-10 implementations draw near.