Ensuring increased revenue and timely re-imbursements through accurate medical coding

Clinical Documentation Improvement

ICD-10 Compliance for Providers

ICD-9-CM to ICD-10-CM and ICD-10-PCS

How are ICD-10-CM and ICD-10-PCS different from ICD-9-CM?

When the original ICD code sets were adopted by the World Health Organization, they did not include procedure codes for facility providers. The ICD-9 code sets included 13,000 diagnosis codes and no procedure codes. At that time, the US healthcare industry added 11,000 facility procedure codes and designated the combined codes set as ICD-9-CM.

The new code sets are now in two segments. ICD-10-CM increases diagnosis codes from 13,000 to 68,000 codes. The accompanying ICD-10-PCS code set includes facility procedure codes and increases the total content from 11,000 to 87,000 codes. The mandated implementation date for both code sets is October 1, 2013.

Vee Bill product suite offers an end-to-end offering to manage the 5010 and ICD 10 transitions. The product suite automates a significant amount of the transition exercise, saving time and money. Leveraging a detailed reference, IT components, VEEBILL extensive domain knowledge can assure a smooth transition experience.

Our Role in Your Success

Our experienced and professional services team can support and augment your internal 5010 migration and ICD-10 upgrade initiatives in the following roles:

  • Audit and review of migration requirements, whether developed by us or the client
  • Project Management
  • HIPAA Migration Readiness Survey
  • 5010 Migration Strategic Planning
  • 5010 Standards Subject Matter Experts
  • 5010 Migration Testing and Validation
  • As Is and To Be Process Models, Facilitation, and Re-Engineering

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What You Need to Know Regarding Compliance HIPAA 5010 Regulations

The Administrative Simplification Act (ASCA) requires the use of electronic claims (except for certain rare exceptions) in order for providers to receive Medicare payment.

  • Therefore, effective January 1, 2012, you must be ready to submit your claims electronically using the X12 Version 5010 and NCPDP Version D.0 standards. This also is a prerequisite for implementing the new ICD-10 codes.
  • The Centers for Medicare & Medicaid Services (CMS) will provide additional information to assist you and keep you apprised of progress on Medicare's implementation of HIPAA 5010 through a variety of communication vehicles.
  • Remember that the HIPAA standards, including the X12 Version 5010 and Version D.0 standards, are national standards and apply to your transactions with all payers, not just with Fee-for-Service (FFS) Medicare.
  • Therefore, you must be prepared to implement these transactions with regard to your non-FFS Medicare business as well. Medicare expects to begin transitioning to the new formats January 1, 2011 and ending the exchange of current formats on January 1, 2012. While the new claim format accommodates the ICD-10 codes, ICD-10 codes will not be accepted as part of the 5010 project.

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