ICD-10 Compliance

ICD-10 Compliance FAQs (Security Health Plan)

ICD-10 compliance means that a HIPAA-covered entity uses ICD-10 codes for health care services provided on or after October 1, 2015. ICD-9 diagnosis and inpatient procedure codes cannot be used for services provided on or after this date. The ICD-10 deadline has been delayed by the federal government until no earlier than  October 1, 2015.

If I transition early to ICD-10, will Security Health Plan be able to process my claims?

No. Security Health Plan and other payers will not be able to process claims using ICD-10 until the effective date. However, we will work with organizations and business trading partners to test software systems throughout the transition process. We will test claims, eligibility verification, quality reporting and other transactions and processes using ICD-10 to make sure the new code set can be processed correctly in the live environment as of the effective date.

Codes change every year. Why is the transition to ICD-10 any different from the annual code changes?

ICD-10 codes are completely different from ICD-9 codes. Currently, ICD-9 codes are mostly numeric and have 3 to 5 digits. ICD-10 codes are alphanumeric and contain 3 to 7 characters. ICD-10 is more robust and descriptive with “one-to-many” matches to ICD-9 in some instances. Like ICD-9 codes are now, ICD-10 codes will be updated every year. ICD-9 codes will not continue to be updated after the ICD-10 effective date.

Why is the switch to ICD-10 happening?

The health care industry is making the transition from ICD-9 to ICD-10 because:

  • ICD-9 codes provide limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, it has outdated and obsolete terms, and is inconsistent with current medical practices. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.
  • ICD-10 codes allow for greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing.
  • ICD-10 coding will make the billing process more streamlined and efficient, and this will also allow for more precise methods of detecting fraud.

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