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On October 1, 2015, health care providers, health plans, and health care clearinghouses successfully implemented ICD-10 coding. The ICD-10 represents a significant improvement over ICD-9-CM by incorporating more specific, clinical detail. This could result in major improvements in the quality and value of coded data which could help improve performance, create efficiencies and control costs.

The added detail in ICD-10 coding allows for the capture of more specific medical information about the diagnoses and procedures used during the health episode. This will help accelerate the electronic processing of claims and reduce requests for additional information.

We're seeing some minor issues about ICD-10 coding. However, we aren't seeing any increase in rejected claims or provider inquiries. We'll continue to monitor claim volumes and track inquiries linked to ICD-10. You can find information on our Important News page about any major impacts.

Highlights Since October 1, 2015 ICD-10 Implementation:
  • BCBSNC tested with various provider entities such as inpatient and outpatient facilities, professional offices, durable medical equipment, labs, and radiology. We processed several hundred test claims, identified and mitigated any processing issues over the nine-month testing period.
  • As of November 1, 2015, nearly 90 percent of our overall claims volume is being submitted with compliant ICD-10 coding.
  • We haven't experienced a significant increase in provider call volumes related to ICD-10.
  • Any ICD-10 coding issues identified have had minimal impact on claims processing and were resolved within 24 hours.
  • BCBSNC continues to process claims within normal claim processing timelines.

We would like to thank our participating providers for their persistence and diligence in successfully implementing ICD-10. We're proud to have such a collaborative relationship with our provider network. We look forward to working together on any future legislative requirements and/or initiatives. For more information about ICD-10, please visit Centers for Medicare & Medicaid Services.

About ICD-10

ICD-10 is different from ICD-9 in the way it is structured and organized. The code composition is much more detailed than ICD-9, allowing for more specificity and detail within the codes. This added detail allows for capture of more detailed medical information regarding the diagnoses and procedures utilized during the episode of care, thereby facilitating timely electronic processing of claims and reducing requests for additional information.

Differences in coding systems:

Consists of 3 to 5 characters Consists of 3 to 7 characters
First position is numeric or alpha (E or V) First position is alpha
Second, third, fifth, sixth positions are numeric Second position is numeric
Always at least 3 digits Positions 3, 5-7 can be alpha or numeric
Decimal in the fourth position Decimal in the fourth position
Alpha characters are not case sensitive Alpha characters are not case sensitive

International Classification of Disease (ICD) is a standard set of diagnosis and procedure codes maintained by The World Health Organization (WHO). ICD codes are used to:

  • Identify symptoms, conditions, problems, complaints or other reasons for medical services or procedures being provided
  • Translate written information in a patient's chart into a form that can be submitted electronically for reimbursement
  • Identify provided procedures and services
  • Establish current world mortality code for death records

The federal government mandated the new ICD-10 code set because it represents a significant improvement over ICD-9-CM by incorporating greater specificity and clinical detail. This will result in major improvements in the quality and usefulness of coded data by providing more specific data to improve performance, create efficiencies and contain costs.

ICD-10 Updates

With the October 1, 2015, implementation date quickly approaching, it's imperative that you stay informed regarding the most current ICD-10 information. The latest information about ICD-10 can be found online at the Center for Medicare & Medicaid Services website.

Blue Cross and Blue Shield of North Carolina is well into its remediation of business, technical and training areas that will be impacted by the ICD-10 conversion.

Provider lack of readiness will create major business disruption for providers and BCBSNC due to increased inquiries, corrected claims and suspended claims. Noncompliance will increase business disruption for provider billing staff and will disrupt provider revenue stream.

ICD-10 Provider Payer Testing Reports

ICD-10 Medical Policy Revisions

View a listing of BCBSNC's medical policies and guidelines, now updated to include policy-specific ICD-10 diagnosis code information. For a complete list of all BCBSNC medical policies, please visit the Medical Policy Updates page.


Industry News

ICD-10 Implementation and Training

CMS and industry partners have developed several helpful resources for use during your conversion to ICD-10. BCBSNC encourages your facility to use and take advantage of these valuable tools. There are implementation guides, timelines and checklists that will enable you to make the transition to ICD-10 easier. You will also find training modules designed for your specific facility type as well as an online implementation tool that is designed to guide you through every step in the process.

Please visit the following website for the most current information and to take advantage of these valuable tools: Provider Resources

CMS Resources and ICD-10 Testing Opportunities

As you implement your solutions consider these points:
  • Even professional providers must be ICD-10 compliant to ensure no disruption to their revenue stream since diagnosis codes are submitted with every claim, and they are changing with ICD-10.
  • If you currently rely on your clearinghouse to reformat HIPAA 4010 transactions into 5010,check with your clearinghouse and ensure you can submit compliant 5010 transactions by 10/1/14.
  • Do you need to upgrade your practice management, billing or EMR system in order to be able to submit compliant ICD-10 coded claims?
  • Have you updated your internal business processes, such as encounter forms, to account for ICD-10 codes?
  • Have you scheduled training in ICD-10 for all your coding/billing staff as well as physicians?
  • Are your physicians ready to include more detailed documentation in their medical records so that the correct ICD-10 code can be assigned?
  • Have you checked with your clearinghouse to make sure they are ready?
This is not an exhaustive list, but is an indication of the types of activities that may be required to avoid disruption to revenue streams.