ICD-10 Project releases operating guidance for capturing ICD-10 diagnosis code(s) for financial clearance activities

Jason Gottlieb

In an effort to prepare NYP for the October 1, 2015 implementation of ICD-10, the ICD-10 Project Management Office will be releasing guidance documents to define various readiness activities that are likely to require some short term operating and procedural contingency during the ICD-10 transition period. The transition period is defined as September 1, 2015 through November 30, 2015. These guidance documents are intended to provide the organization with broad based instruction on how to manage these contingencies. Each department, operating area, and service should apply this guidance (as applicable) to its specific operating idiosyncrasies that only they are uniquely qualified to account for.

The purpose of this guidance document is to provide direction as to how operating owners can ensure ICD-10 codes are properly collected, determined, and assigned to encounters so as to support effective financial clearance activity during the ICD-10 transition period. Effective for calendar date September 1, 2015, it is expected that service lines and operating areas that own or otherwise bear the responsibility for scheduling, pre-registration, and financial clearance procedures work collaboratively with upstream data providers to collect, determine, and/or assign accurate ICD-10 codes as applicable and defined. Generally speaking, scheduled services for October 1, 2015 and forward shall require the provision of ICD-10 diagnosis codes to third party insurance carriers for purposes of service authorization.  Specifically, the guidance includes date of service/date of discharge sensitive protocols for the following six major categories of service:

  • Inpatient
  • Ambulatory Surgery
  • Emergency Department
  • Hospital Based Clinic (HBC)
  • Therapeutic Referred Ambulatory (TRA) or (e.g. – PT/OT, Behavioral Health, Chemotherapy, Radiation Oncology, etc.)
  • Diagnostic Referred Ambulatory (DRA) or (e.g. – Radiology, Lab, EKG, Nuclear medicine, etc.)

Operating areas may work with the ICD-10 Project Management Office and/or IT owners of specifically affected applications to ensure a smooth transition.