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    ICD10 and HIPAA 5010 - Game Changers
    By Jack Beaudoin, VP, Content - Posted on 12 March 2010

    ATLANTA If you were hoping that the transition to HIPAA 5010 and ICD10 would be easy, think again. "I don't think this is going to be simple at all," observed Joseph Nichols MD, Medical Director of Edifecs. "It's very, very complex. But I do think there will be lots of advantages to the transition, lots of long-term benefits."

    Complexity and benefits were the dominant theme of "The Health Data Transaction Ecosystem," the first substantiative session of the Medical Banking Boot Camp on Sunday, presented by Nichols and Edifecs CEO Sunny Singh.

    Singh covered the 5010 transition, scheduled to go into effect next year. Singh warned boot campers not to underestimate the complexity of the transition, and advised his listeners to test, test and then test again prior to going live. Key to success will be developing a unified compliance strategy across all channels of transaction and information processing.

    "Just saying 'I can send a good file' or 'I can receive a file' is just inadequate," Singh said. The whole information chain, from the time a message is received until it is fully processed, reported and acknowledged, needs to be tested.

    Nichols then turned the session's attention to ICD10. While the compliance date for ICD10 is October, 2013, Nichols said the transformative nature of the transition required planning to start immediately.

    "Y2K was a big deal not because you needed to change two digits, but because it was pervasive and embedded across all systems," he said. Similarly, ICD codes are embedded in many clinical and financial systems. "There are many technologies that will be effected."

    Some in the industry are pinning their hopes to translating old ICD9 codes to new ICD10 codes, and vice versa. But Nichols pointed out that just five percent of all ICD10 codes map directly to ICD9 codes, and only 26% of ICD9 codes map to ICD10 codes.

    "Translation is going to be a big issue," he said, noting that all other codes will lose information or assume information that's not true when they are mapped.

    Despite the pain of the transition, Nichols said that the amount of information encoded in ICD10 would create opportunities to leverage the codes for greater efficiencies and accuracy.


    2010 CPT Code Changes


    Evaluation & Management Services Guide (CMS-July 2009)
    1997 E/M Documentation Guidelines
    1995 E/M Documentation Guidelines
    E/M Pocket Guide (Trailblazer Health: 2008)

    History Documentation

    Documenting a History (Tulane University Medical Group)
    Highmark Medicare Services HPI Elements (Reviewed 05/13/08)


    Highmark Medicare Services FAQ (Reviewed 2/13/2008)
    Wisconsin Medical Society FAQ (2008)
    Medicare Physician Guide (CMS-July 2007)
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