The ICD-10 Initiative
The ICD-10 initiative is upon all of us in the behavioral health industry. Logik Solutions is in the midst of changes and enhancements to our software to facilitate the transition from ICD-9 to ICD-10. Below is a discussion of what we are doing to prepare and ensure our clients have a smooth transition to the ICD-10.
First, there is no longer any ambiguity about the “go-live” for ICD-10 at October 1, 2014. Professional component services and inpatient discharges on or after this date must be coded in ICD-10.
The components of MEDIK that must be addressed include:
- A new user interface to accommodate the ICD-10 diagnosis entry. Fields in MEDIK presently used to record ICD-9 diagnoses are being expanded to accept the seven digit ICD-10 values. Unlike ICD-9, the new nomenclature can be composed of alpha/numeric values. A diagram of that format looks like this:
- The new user interface will be tied to the ICD-10 “table” which is similar to the ICD-9 table—though much larger. We have obtained the ICD-10 table. There is some question as to whether the current edition of the Fiscal Year 2014 table will be updated again in July, 2014. If the table does change again in July, the version loaded to your site will be upgraded. Well before October 1, 2014 we will load the ‘latest and greatest’ iteration of the table to your MEDIK data base.
- For those of you who have examined the table in detail you realize the diagnostic codes for behavioral health diagnoses are isolated in the Fx.x range. Logik Solutions will include a new feature called “Preferred Diagnosis.” Users may choose to affiliate the Preferred Diagnosis flag with the behavioral health diagnoses. This feature will limit the initial diagnoses presented as a choice when entering a diagnosis in the patients’ admission records. However, users may also designate ANY of the 155,000 ICD-10 diagnoses as a ‘Preferred Diagnosis.” We believe this feature will save time when choosing and posting diagnoses.
- There are about 200 programs in MEDIK that call diagnoses or present the diagnoses to various reports. Logik Solutions programming staff are combing through those programs to update diagnosis formats to seven characters. We will begin rolling out these reports soon. You may notice that until ICD-10 codes are used regularly after October 1, 2014, that there is a little extra space in the ICD-9 report format fields on your various diagnosis reports.
- Billing formats will have to be updated to reflect the ICD-10. The UB-04 is already formatted to accept the new format. The HIPAA compliant electronic 837 files use the same segment/loop to reflect the diagnosis as the ICD-10; however there is a qualifier appended to that segment/loop reflecting that the diagnosis is expressed as a “10.”
- Bill format testing will commence shortly after January 1. There are two layers of testing that resemble the testing requirements experienced during prior industry initiatives, such as the implementation of HIPAA compliant 837’s, or the “5010” project:
- Format testing at the “clearing house level.” For clients using MEDIK and submitting claims through ZirMed this will be handled between Logik Solutions and ZirMed. ZirMed already has a test data base set up to accept the ICD-10 diagnoses; check file structure, format, etc.
- For clients who directly submit 837 claims to payers or fiscal intermediates, we will need to test. This includes nearly every Arkansas and several Pennsylvania clients. We will be contacting you to arrange for a series of test claims to be developed and submitted. The timing of this testing will depend upon the willingness of the payer or FI to participate and their published schedule for testing.
- A special note regarding Medicare: Presently all information from CMS indicates they will NOT participate in testing the ICD-10, at all. Ostensibly they will “flip a switch” on October 1 and commence receiving diagnoses on that date. There are various movements afoot from professional organizations, clearing houses, and providers asking CMS to reconsider this position. Stay tuned.
- Even with sufficient notice, we recognize there will be payers or fiscal intermediaries who will not be prepared to receive claims with the ICD-10 diagnostic nomenclature. As in past initiatives of similar magnitude, e.g., 5010, and even the UB-04 conversion, Logik Solutions will have a mechanism in place to send ICD-9’s on claims to specific payers. This will be accomplished in a fashion to optimize user convenience. With the roll out of our ICD-10 user interface all insurance payers in MEDIK will be set to use ICD-10, by default after October 1, 2014. There will be a “flag” for ICD-10 that can be “unchecked” for the payers/insurance companies not yet accepting the new codes. This leads to the issue of ICD-10 to ICD-9 cross-walks.
- We have consulted ICD-10 transition experts and learned that ICD-9 to ICD-10 cross walking is impractical. With this in mind, Logik Solutions will offer the feature to enter ICD-10 diagnoses for ALL payers, but preserve a mechanism to enter ICD-9 diagnoses for those exceptional payers not prepared for the ICD-10.
- PPS calculation software referencing ICD-10 is NOT yet ready. We have received word from the industry supplier that the tables/algorithms for those calculations will be ready by July, 2014. Just as soon as those calculation files are available we will install those calculation files for the PPS calculator in advance of October, 2014.
- In many regards we are all in the ‘hurry-up-and-wait” mode as the ICD-10 is put in place by clients, payers, clearing houses, etc. However, like so many similar events in our industry over the past few years Logik Solutions is addressing the changes in a proactive fashion on behalf of our clients to ensure a smooth transition.