Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has released an "ICD-10 Next Steps for Providers Assessment & Maintenance Toolkit."

The toolkit is intended to help providers track and improve ICD-10 progress with information and resources.

Areas of focus include:

  • Assessing your ICD-10 progress using key performance indicators (KPIs) to identify potential issues that could affect productivity or cash flow
  • Addressing opportunities for improvement, including troubleshooting issues identified during your assessment and deploying tactics like system enhancements and targeted staff training
  • Maintaining your progress and keeping up to date on ICD-10

ICD-10 KPIs

The toolkit provides a lengthy list of KPIs providers can consider tracking and comparing data before and after the October 1, 2015, ICD-10 effective date. KPIs recommended for consideration include the following:

  • Days to final bill
  • Days to payment
  • Claims acceptance/rejection rates
  • Claims denial rate
  • Coder productivity
  • Daily charges/claims
  • Incomplete or missing charges
  • Incomplete or missing diagnosis codes
  • Medical necessity pass rate

The toolkit also provides a series of helpful tips.

To access the ICD-10 toolkit, click here.

ICD-10 Resources

For additional ICD-10 resources, check out the practice management tools from PGM Billing, a leading provider or practice management solutions. Tools include ICD-9 to ICD-10 crosswalks, ICD-10 code lookup tool, ICD-9 to ICD-10 code conversion tool, and ICD-10 education.

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder about how healthcare providers should use qualifiers for ICD-10 diagnosis codes submitted on electronic claims.

CMS notes that when you submit electronic claims for services, remember the following:

  • Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10.
  • Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can use ICD-9.

Use ICD-10 qualifiers as follows:

  • For ASC X12 837P 5010A1 claims, the HI01-1 field for the Code List Qualifier Code must contain the code "ABK" to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code "ABF" for the Code List Qualifier Code to indicate up to 11 additional ICD-10 diagnosis codes that are sent.
  • For ASC X12 837I 5010A1 claims, the HI01-1 field for the Principal Diagnosis Code List Qualifier Code must contain the code "ABK" to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code "ABF" for each Other Diagnosis Code to indicate up to 24 additional ICD-10 diagnosis codes that are sent.
  • For NCPDP D.0 claims, in the 492.WE field for the Diagnosis Code Qualifier, use the code "02" to indicate an ICD-10 diagnosis code is being sent.

For more assistance with ICD-10, check out the practice management tools from PGM Billing, a leading electronic medical billing service provider.

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