The HIPAA Claim Master is ready for ICD-10

With the change of the healthcare industry to ICD-10 (International Classification of Diseases 10th revision) it becomes necessary to keep track of the version of a diagnosis code within a claim alongside the diagnosis code itself.

Our software internally stores every bit of information with in an EDI file so there is no issue whether diagnosis codes are ICD-9 or ICD-10. In order to make the version available for the SQL database we at HIPAAsuite decided against creating another 40 or so fields in the database since the claim header table just gets more unwieldy and we decided to store the version and incidentally the Present On Admission (POA) indicator in addition within the the same diagnosis code field delimited by colons. This way the information is where it belongs, right alongside the diagnosis code and database administrators and programmers can easily access the version codes and POA codes with some form of split function inherent to all SQL languages.

Whether you use the HIPAA Claim Master for the creation of 837 EDI files from database records or for translating EDI files into database records, please be aware of this mechanism to smoothly transition to ICD-10.

Read further for the explicit details

You can set the HIPAA Claim Master to export POA and ICD Version information with Diagnosis Codes, separated by a colons. Under the Setup menu is the item 'Specific Options'.

The Setup menu

The 'Specific Options' menu

The following screen comes up

Options form

The option to export ICD and POA information alongside the diagnosis code

Here you can determine whether the ICD version and the POA indicator are saved within the code field, making it multi-valued. Remember. When creating 837 files with ICD-10 codes it is necessary to have the ICD-10 version indicator present in the field.  If this checkbox is unchecked you will not be able to properly identify the ICD version! The new default behavior is that POA and ICD version will be saved to database.

Present on Admission (POA) information is now often required by insurers to exclude "hospital infections" from coverage. These are diseases that are acquired by the patient after admission to the hospital and often cause high costs and even death. In the SQL export the POA codes are colon separated from the diagnosis codes.

With the introduction of ICD-10 it is important to save the version of ICD codes that are in the claim to the database.

Since it is intrinsically linked to the Diagnosis code we decided against creating another set of fields. It would mean creating another 80 or so fields for POA and ICD version. Instead we opted to concatenate the ICD version qualifier  and the POA indicator with  Diagnosis Code qualifier separated by a colon ':'

 

  • The Principal Diagnosis Code has POA and ICD version.
    • Example:  Z77.22:Y:ABK with the diagnosis code in first position, followed by the  POA indicator 'Y' and the ICD-10 qualifier
  • Other Diagnosis Codes have POA and ICD version. same as above
    • Example: J151::ABF  Here the POA code is omitted
  • E-Codes also have both POA and ICD version, same as above
    • Example E8600:Y:ABN
  • Admit Diagnosis Code has no POA info. By definition is the diagnosis code under which a patient was admitted present at admission.
    •  Example T8741:ABJ Only the ICD version qualifier is added to the diagnosis code
  • Reason for Visit Codes have no POA info. Same as Admit diagnosis
    • Example R110:APR ICD version after the code

This way of connecting diagnosis information with POA and ICD codes is bi-directional, meaning if you create 837 files from database, than the above is the way to do it. Internally HIPAA Claim Master will parse out the information and assemble the respective HI segment within all applicable rules. If no explicit ICD information is availalbe, the program assumes ICD-9 by default.

 

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