Health Information Management

Q&A: ICD-10-CM/PCS and ICD-9-CM dual systems

HIM-HIPAA Insider, May 24, 2011

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Q: In what instances would a dual system be necessary after ICD-10 takes effect?

A: One example of where the use of a dual system may be necessary is for you to segregate your managed care contracts. If you have contracts established under MS-DRGs based on ICD-9-CM codes, the managed care contract application that feeds information to your billing system may not be able to accommodate MS-DRGs with ICD-10-CM/PCS codes simultaneously. So you may actually need to run two contract management systems. That would be a dual system application.
In addition, if you're changing information systems, you may need to run your prior claim processing version (4010) through the end of your claims remittance process for any claims issued under that version. You may find that your information system is unable to accommodate both versions simultaneously. If this is the case, you may have to purchase and run the new system with 5010 and maintain your legacy system with 4010 if conversion capabilities are not available.
Some of the advance beneficiary notice (ABN) applications may also need a dual system application because they may not be able to accommodate the current local coverage determinations (LCD) and the revised LCDs that Medicare may release and the LCD-like information coming out from specific payers. So you'd run your ABN application for services generated through September 30, 2013, then your new application would run for services as of October 1, 2013. That dual time period is going to be short because of the transition date for the date of services and because those services are typically outpatient.
The last challenge is that, as a HIPAA transaction set, ICD-10-CM/PCS does not apply to motor vehicle insurers or workers' compensation. So you may need to have a dual system running to be able to issue claims with ICD-9-CM codes for those two payers and possibly process claims through the 4010 transaction set. Those payers aren't covered under HIPAA, so they're technically not required to change. This may require some claims to be coded in ICD-9-CM, while others will be coded in ICD-10-CM/PCS.
Editor’s note: Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, chief operating officer of First Class Solutions, Inc., in Maryland Heights, MO, answered this question in the May issue of Medical Records Briefing.

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