CMS completes first week of ICD-10 end-to-end testing

The CMS concluded its first successful end-to-end testing week of the new ICD-10 coding, the agency announced in a blog post.

“Testing allows us to identify areas of improvement, and we will work with outside entities and stakeholders to improve those very small deficiencies identified,” Marilyn B. Tavenner, administrator for the CMS, said in the post. “And we will continue to do testing, especially in those areas we identify as needing improvement.”

The testing entailed nearly 15,000 test claims submitted by approximately 660 providers and billing companies. The successful test week represents another key step toward the target date of Oct. 1 for the introduction of the new ICD-10 codes.

Marilyn B. Tavenner

Currently, most countries are already using the 10th revision of the ICD code, but the United States has not yet implemented the revision. ICD-10 codes are more specific than ICD-9 codes, availing practitioners of more detailed and precise information about a patient’s health. ICD-9 is more than 35 years old and places limits on the number of new codes that can be created. Currently, many ICD-9 categories are full. ICD-10 allows for code expansion, enabling practitioners to use codes that most precisely reflect the patient diagnoses.
The United States is the last major industrialized country to transition to the ICD-10 revision.

During the week of testing, which took place between Jan. 26 and Feb. 3, participants were largely successful in submitting ICD-10 claims and having them processed through the CMS billing systems. Of the 14,929 test claims submitted, 12,149 (81%) were accepted. Of the claims that were rejected, 3% were due to invalid submission of an ICD-9 diagnosis or procedure code, 3% were due to invalid submission of an ICD-10 diagnosis or procedure code, and 13% were non–ICD-10 related problems, such as issues setting up the test claims (incorrect National Provider Identifiers, Health Insurance Claim Number, Submitter ID, dates of service outside the range valid for testing, invalid Healthcare Common Procedure Coding System codes or invalid place of service).

In the blog post, Tavenner clarified that everyone must use ICD-9 codes for services provided before the Oct. 1 deadline and ICD-10 codes for services provided on or after Oct. 1.
“That means ICD-10 can be used only for test purposes before Oct. 1,” Tavenner said in the post. “And, only ICD-10 can be used for doctor’s visits and other services that happen on or after Oct. 1. ICD-9 cannot be used to bill for services provided on or after Oct. 1.”

Tavenner encouraged medical practices and hospitals that bill Medicare to utilize available testing opportunities. Besides testing, CMS is offering outreach, training and educational resources to prepare health care providers for ICD-10. Providers are encouraged to visit the website cms.gov/ICD-10, which provides resources to aid in ICD-10 implementation.

“CMS is ready for ICD-10,” Tavenner said in the post. “And, thanks to our many partners — spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups — the health care community at large will be ready for ICD-10 on Oct. 1.”