Saturday, January 31, 2015

ICD-10 Conversations - Almost Every Day of the Week!

About four years ago when I was just starting to get involved with the ICD-10 mandate, there was a dearth of information about ICD-10 available on the web.  That's all changed.  Anyone who has anything to do with ICD-10 doesn't have to start from scratch. There's plenty of good information freely available to anyone who knows how to do a simple search.

And a couple organizations have stepped up with recurring programs aimed at sharing a wide range of ICD-10 related content. Here are a few of the more popular programs:

Talk Ten Tuesdays – Stay on Top of the Game

This weekly program, sponsored by ICD10monitor, a division of Panacea Healthcare Solutions, Inc., is an online news and information source created to help healthcare providers make informed decisions as they transition to ICD-10. Here's a link to their upcoming broadcasts and their archives.

I think Talk Ten Tuesdays was one of the first recurring programs about ICD-10. Chuck Buck is the lead moderator of Talk Ten Tuesdays - quite the character and always entertaining - AND informative! You can follow @ICD10Monitor here.

What’s Up Wednesdays – Together Let’s Get ICD-10 Ready

This program is sponsored by BlueCross of Northeastern Pennsylvania. You can find program information here and recordings from previous shows here. Here's information from their most recent program on January 21, 2015.

Open Line Fridays 

This monthly program is sponsored by FLBlue and offered In alliance with representatives from Baptist Health South Florida, Lee Memorial Hospital, Mayo Clinic, Tampa General Hospital, Availity®1 LLC, Secure EDI, Springs Family Physicians LLC, and Health Data Consulting. You can find program information here and recordings from previous shows here. 

George Vancore is the lead moderator for Open Line Fridays and, like Chuck Buck, is quite the character and always adds a lot of fun to an already exciting topic! You can follow @FLBlue here.

What about Monday's and Thursday's?

So who's going to fill these slots?

For more information on ICD-10 and other health information technology-related topics, be sure to subscribe to this blog and consider following me on Twitter.

Tuesday, January 27, 2015

ICD-10 Codes in Non-Claim HIPAA Transactions

Most everyone involved with ICD-10 knows that the HIPAA 837 Healthcare Claims Transactions (Professional, Institutional & Dental) contain ICD-10 diagnosis and procedure codes and, therefore, must be considered when making their systems and processes ICD-10 compliant. But what other HIPAA transactions contain ICD-10 diagnosis and procedure codes?

Based on the amount of information shared on the web and some cursory research I’ve performed looking for information and guidance on non-claim HIPAA transactions impacted by ICD-10, it appears that not many people are aware that there are other HIPAA transactions that can also contain ICD-10 codes.

Which Non-Claim HIPAA Transactions Contain ICD-10 Codes?

WEDi has published a document titled “ICD-10 Impact to HIPAA Transactions”  that identifies all HIPAA transactions impacted by ICD-10. These HIPAA transactions include the following:

Healthcare Eligibility Benefit Inquiry and Response (270 & 271)

These two transactions includes the following:

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code
2. Procedure Codes and a Procedure Code Qualifier for each code

Benefit Enrollment and Maintenance (834)

This transaction includes Diagnosis Codes and a Diagnosis Code Qualifier for each code.

Healthcare Services Review – Request for Review and Response (278)

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code.
2. Procedure Codes and a Procedure Code Qualifier for each code.
3. Surgical Procedure Codes and a Surgical Procedure Code Qualifier for each code.

But We’ve Already Addressed this via our 5010 Upgrade!

Just because your organization is 5010 compliant doesn’t necessarily mean you’re out of the woods with your HIPAA transactions when it comes to ICD-10. Most 5010 upgrades merely tested the format of 5010 transactions and their ability to carry ICD-10 codes and qualifiers. Little, if any, focus was likley given to making sure ICD-10 procedure and ICD-10 diagnosis codes were correctly assigned to the transactions and that the transactions were correctly processed in applications: front-end or downstream. 

And it seems unlikely many organizations got into testing various processing scenarios.

Special Processing Scenarios. Like What?

There are some special processing scenarios organizations may want to consider when addressing the 278 Healthcare Services Review transactions. For instance,

What is the appropriate response to a 278 referral inquiry if the inquiry is submitted after 10/1/2015 but the original referral request was submitted prior to 10/1/2015? Is it ok to respond with a transaction containing ICD-9 codes? Will the transaction even pass any transaction compliance checks performed by your EDI tools or clearinghouse?

What about a request for a referral extension? Referrals submitted prior to 10/1/2015 will contain ICD-9 codes and would typically be valid for up to a year. If a referral request extension is submitted on 10/2/2015, which ICD code set should be used? 

I’m sure there are other considerations.

It’s Imperative!

As WEDI states in the document I noted above: “it is imperative that we have a clear understanding of where the ICD-10-CM and ICD-10-PCS codes are used in the transactions required under HIPAA and used in the health care industry to exchange diagnosis and procedure information.