Home Page > Industry Regulations > Frequently Asked Questions: 5010 and ICD-10

Frequently Asked Questions: 5010 and ICD-10

As the deadlines for transitioning to HIPAA 5010 and ICD-10 rapidly approach, all practices are beginning to wonder what they should be doing to prepare for the changes. To help prepare practices for the transitions, we will be answering some of the most common questions about 5010 and ICD-10 in the coming months.

  • How do we update to 5010? Depending on your practice’s stance, everyone will make this transition differently. A lot of this also depends on how you submit claims. For example, many clearinghouses are working to implement processes that will automatically convert data into the proper format. With that being said, every practice should check with their healthcare technology (HIT) vendors to find out what steps they will be required to take and how the transitions will impact them. If you don’t have a clearinghouse, you will have to test with every one of your direct payers.
  • Do all practices have to migrate to ICD-10 and 5010 by January 1, 2012? No, January 1, 2012 is the cutoff date for transitioning to HIPAA 5010. However, ICD-10 code sets will not take effect until October 1, 2013. The two transitions are linked, but are not the same so they have different timelines for implementation. 5010 is necessary to allow ICD-10 codes to be processed but does not require ICD-10 codes for use.
  • What is the dependent change in 5010? Today’s Medicare and Medicaid are set up so that each member of the plan has a unique identifier and this is commonly done with many other plans. In 5010, this change will also impact all other payers that give all plan members a unique identifier and will require that dependents with a unique identifier be submitted as the subscriber. It will be essential to learn which payers do this and which ones don’t once 5010 is implemented.
  • If you are on a large clearinghouse and nationally-known practice management system, what is there left for a practice to do in order to prepare for 5010? Although many HIT vendors are going to take the transmitted data and make sure that it is 5010 compliant, there are a few things that practices must do to allow the HIT vendor to successfully make that transition. Practices will be responsible for submitting both a billing and pay-to address if applicable. If practices do not submit this information correctly, the HIT vendor will not be able to correctly convert the data to 5010 standards.
  • Our practice management vendor has told us they’ll be testing the 5010 transactions and they will be transparent with us. Should I question them and establish our own test data? Don’t be satisfied with a canned answer that “we tested and it all works.” You should ask what types of claims were tested. If the types of claims that apply to your practice were not tested, I strongly recommend testing. Regardless, if you have any doubts at all that the claim files your practice submits were not tested properly or at all, I recommend testing the files yourself. This will help ease your mind.
  • How long will ICD-9 and ICD-10 be in use concurrently? If you look at how long your practice currently takes to go through the entire process – submitting, reviewing, refilling and appealing claims – you will get a good feel for how long ICD-9 will still be used in your practice. So if you go back and review claims from three months ago today, you will need to use ICD-9 for three months after the transition.

­Do you have a 5010 or ICD-10 question that you would like answered? Leave us a comment or submit an idea in the column box on the right side of the blog and we will answer it in an upcoming post.