2. AGENDA
• INTRODUCTION TO ICD10
• WHO NEEDS ICD10-TRANSITION
• TECHNOLOGY INVOLVED FOR THIS MIGRATION
• HOW END-TO-END TESTING IS ACCOMPLISHED
• CHALLENGES FACED
• ICD-10 COUNTDOWN DAYS.
• INSIGHTS OF MEDICAL PROFESSIONALS
• Q&A
3. INTRODUCTION TO ICD10
• ABBREVATION
ICD-10 -THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED
HEALTH PROBLEMS , SHORTLY CALLED AS INTERNATIONAL CLASSIFICATION OF
DISEASES 10TH REVISION.
• MIGRATION FROM ICD-9 TO ICD-10 (MODERN HISTORY OF THE MEDICAL DICTIONARY WITH ICD-10)
THE ICD IS MAINTAINED BY THE WORLD HEALTH ORGANIZATION(WHO) THE DIRECTING
AND COORDINATING AUTHORITY FOR HEALTH WITHIN THE UNITED NATIONS SYSTEM.
4. DIFFERENCE BETWEEN ICD-9 AND ICD-10 DIAGNOSIS
CODES
ICD-9 ICD-10
3-5 characters in Length 3-7 characters in Length
Approximately 13,000 codes Approximately 68,000 available codes
First digit may be alpha(E or V) or numeric,
digit 2-5 are numeric
Digit 1 is alpha; digit 2 and 3 are numeric;
digit 4-7 are alpha or numeric
Limited space for adding new codes Flexible for adding new codes
Lacks detail Very Specific
5. • THE EXPANDED NUMBER OF CHARACTERS OF THE ICD-10 DIAGNOSIS CODES
PROVIDES GREATER SPECIFICITY TO IDENTIFY DISEASE ETIOLOGY, ANATOMIC
SITE AND SEVERITY.
• ICD-10 CODE STRUCTURE:
CHARACTERS 1-3 –CATEGORY
CHARACTERS 4-6-ETIOLOGY,ANATOMIC SITE, SEVERITY OR OTHER CLINICAL
DETAIL
CHARACTERS 7-EXTENSION
6. ICD-10 DIAGNOSIS CODE EXAMPLE
• S52 FRACTURE OF FOREARM
• S52.5 FRACTURE OF LOWER END OF RADIUS
• S52.52 TORUS FRACTURE OF LOWER END OF RADIUS
• S52.521 TORUS FRACTURE OF LOWER END OF RIGHT RADIUS
• S52.521A TORUS FRACTURE OF LOWER END OF RIGHT RADIUS, INITIAL ENCOUNTER FOR
CLOSED FRACTURE.
S52 IS THE CATEGORY. THE FOURTH AND FIFTH CHARACTERS OF “5” AND “2” PROVIDE
ADDIONAL CLINICAL DETAIL AND ANATOMIC SITE. THE SIXTH CHARACTER IN THIS EXAMPLE
INDICATES LATERALITY I,E RIGHT RADIUS. THE SEVENTH CHARACTER “A” IS AN EXTENSION THAT
PROVIDES ADDITIONAL INFORMATION, WHICH MEANS “INITIAL ENCOUNTER” IN THIS EXAMPLE.
7. DIFFERENCE BETWEEN ICD-9 PROCEDURE CODES AND
ICD-10 PROCEDURE CODES
ICD-9-PCS ICD-10-PCS
3-4 digits 7 digits
All digits are Numeric Digits can be either alpha or numeric.Letters
O and I are not used to avoid confusion with
the numbers 0 and 1
Decimal after first 3 characters Decimal after first 3 characters
Examples
43.5 - Partial gastrectomy with anastomosis
to esophagus
44.42 - Suture of duodenal ulcer site.
0FB03ZX - Excision of Liver, Percutaneous
Approach, Diagnostic
0DQ10ZZ - Repair upper esophagus, open
approach
8. WHO NEEDS ICD10 TRANSITION
• PROVIDERS, PAYERS(INSURANCE COMPANIES), CLEARINGHOUSES AND BILLING
SERVICES WHO EVER COVERED BY HIPAA (HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT) .
• ALL ELECTRONIC TRANSACTIONS MUST USE 5010 STANDARDS WHICH HAVE
BEEN REQUIRED SINCE JANUARY 1,2012. 5010 ACCOMMODATES -1CD10
DIAGNOSIS CODES AND ICD10 PROCEDURE CODES.
• ICD-10 DIAGNOSIS CODES MUST BE USED FOR ALL HEALTHCARE SERVICES
PROVIDED IN UNITED STATES . ICD-10 PROCEDURE CODES SHOULD BE USED
FOR HOSPITAL INPATIENT AND OUTPATIENT BILLS.
10. END-TO-END TESTING
TESTING APPROACH.
REQUESTED FROM THE CLIENTS TO SEND THE CLAIMS DATA, PROVIDER DATA, EREVIEW BILLS, BILLS IN 5010 FORMAT OR ANSI-X12
STANDARD FORMAT . INBOUND PROCESS INVOLVED TO IMPORT THE CLAIMS DATA, PROVIDER DATA AND BILLS IN THE STANDARDS (
EREVIEW, 5010 OR ANSI-X12). OUTBOUND PROCESS INVOLVED TO SEND THE ACK FILE AND PAYMENT FILES.
ENVIRONMENT USED TO ACHIEVE THE TESTING
• EDI ENVIRONMENT
• B2WBF ENVIRONMENT
11. TEST ENVIRONMENT -EDI
• STEP 1: TEST ENVIRONMENT SETUP
• STEP 2: TEST DATA PREPARATION
• STEP 3: GENERATE THE TEST FILES
• STEP 4: SHARE THE TEST FILES /ACK FILES WITH CLIENTS.
16. TEST ENVIRONMENT – B2BWF
• STEP 1: TEST ENVIRONMENT SETUP
• STEP 2: TEST DATA PREPARATION
• STEP 3: GENERATE THE TEST FILES
• STEP 4: SHARE THE TEST FILES /ACK FILES WITH CLIENTS.
18. CHALLENGES FACED
• TEST PLANNING AND EXTREME COORDINATION NEEDED WITH PROJECT
MANAGEMENT, BUSINESS ANALYST, DEVELOPMENT TEAM , TECHNICAL SERVICES
TEAM AND WITH PARTNERS.
• 80% TESTING INVOLVED MANUAL DATA VERIFICATION AND 20% OF TESTING
ACHIEVED BY INTERNALLY DEVELOPED REGRESSION EDI AUTOMATION TOOL.
