Stream: CARIN IG for Blue Button®
Topic: ICD9 & ICD10 Support
Jason Teeple (Aug 04 2020 at 12:40):
@Amol Vyas @Ryan Howells @Mark Roberts is the CPCDS IG supporting both ICD9 and ICD10 or just the latter?
Amol Vyas (Aug 04 2020 at 17:52):
For claims/encounters with date of service > 1/1/2016, it will be just ICD-10.
Jason Teeple (Aug 04 2020 at 19:01):
Interesting.... some providers are still using ICD9 for paper bills and claim data from external partners who are not required to restrict to ICD10 (like vision). Seems like this is a gap from the IG perspective. ICD10 is only required for HIPAA transactions. @Amol Vyas
Josh Lamb (Aug 04 2020 at 19:48):
https://www.cms.gov/Medicare/Coding/ICD10 I believe that payers have only been submitting ICD10 codes for claims since the end of 2015.
Jason Teeple (Aug 04 2020 at 20:21):
I agree with the Medicare statement. QHP's are different though and providers still submit non HIPAA transactions. @Amol Vyas @Ryan Howells @Mark Roberts
Ryan Howells (Aug 06 2020 at 18:34):
@Jason Teeple We did not account for ICD9 codes since the CMS rule only requires claims to be sent with a DOS 1/1/2016 or later. When we spoke with CMS early on, we learned one of the reasons they chose that date was because they wanted a clean break between ICD9 and ICD10. I don't think anyone (including CMS) contemplated this use case. What percentage of your total claims would fall under this scenario?
Jason Teeple (Aug 06 2020 at 19:02):
@Ryan Howells I have asked my team to come back with a percentage. They did a quick look at QHP claims and saw a good number of IC9s. Hopefully I will have numbers later today.
Amol Vyas (Aug 07 2020 at 19:59):
@MaryKay McDaniel , @Mark Scrimshire , @Robert Dieterle , @Pat Taylor for their take on the ICD-9 question.
Jason Teeple (Aug 19 2020 at 19:11):
@MaryKay McDaniel @Mark Scrimshire @Robert Dieterle @Pat Taylor Any update on the above question?
Robert Dieterle (Aug 19 2020 at 19:44):
Interesting question -- EnableCare is still receiving ICD9 codes from a number of significant provider organization in our clinical transactions (including ADT). I assume that this is the same for most payers. We most likely will need to support ICD9 codes in PDex.
Jason Teeple (Aug 19 2020 at 20:35):
@Robert Dieterle your assumption is correct. I believe the IG needs to be enhanced to support ICD9 codes.
Jason Teeple (Aug 20 2020 at 11:08):
Would it be acceptable to instruct mapping teams to use ICD9 since this issue is not unique to one payer?
@MaryKay McDaniel @Mark Scrimshire @Amol Vyas @Pat Taylor
Pat Taylor (Aug 20 2020 at 11:43):
Hi Jason, the CARIN team is considering the option. May we get back to you in a day or so? @Ryan Howells
Ryan Howells (Aug 20 2020 at 12:08):
@Jason Teeple Our plan is to discuss it on today's Ballot reconciliation call to get the community's feedback. Will you be on the call today to explain what you are seeing 'in the wild'?
Jason Teeple (Aug 20 2020 at 13:21):
Don't believe I have that meeting on my calendar. When is it?
Ryan Howells (Aug 20 2020 at 15:03):
11am ET https://leavittpartners.zoom.us/j/93372147617. We'll get you added. It's on an open call and on the HL7 site.
MaryKay McDaniel (Aug 20 2020 at 21:08):
I'm not an attorney and willing for those who translate law into operational policies to provide a better understanding, but the code set rule wasn't tied to 'mandated' transactions - it says "electronic transactions", not "mandated transactions". There was also a FAQ about this in the olden days, which I can't find. But, transactions were defined as an electronic exchange of information between two parties to carry out financial or administrative activities related to health care. Wouldn't this exchange qualify as "electronic" and as such require ICD-10?
Pat Taylor (Aug 22 2020 at 12:33):
@MaryKay McDaniel My understanding is that these are paper claims, so you raise a good question. @Jason Teeple This item has been added to the CARIN WG call. The calls occur twice a week, Mondays at 2:30 ET and Thursdays at 11 ET. Would you be willing to join the call to share what you are seeing? @Ryan Howells @Mark Roberts @Amol Vyas @Saul Kravitz
Last updated: Apr 12 2022 at 19:14 UTC
