ICD-10 FAQs

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ICD-10 frequently asked questions

What is Aetna's position on the final rules?

We plan to meet all applicable compliance timeframes. We also continue to work closely with providers and clearinghouses, exchanging information in preparation for ICD-10 implementation and compliance.

The more detailed coding brings the United States in line with countries that have already adopted ICD-10. The ICD-10 codes allow for more specific descriptions, which improves the accuracy of claims payments and coverage decisions.

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act, which addresses a variety of health policy issues. One of those issues is a delay in the transition from ICD-9 to ICD-10 code sets. The law states: The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.

We will continue working on our ICD-10 projects to ensure that our systems, vendor tools, and business processes and policies will be ready for the new compliance date. We’ll follow guidance from the Department of Health and Human Services and Centers for Medicare & Medicaid Services. We will work closely with the medical community to monitor compliance and manage risk.

What is Aetna's approach to testing?

Targeted external testing is under way. We will test with targeted providers throughout 2014 and 2015. Watch for information later this year on our testing results.

We selected our testing partners based on several factors. One is ICD-10's effect on your contract's reimbursement methodology. We recommend contacting your clearinghouse to test with them.

What should doctors and facilities do to prepare for the compliance date?

Providers should contact their billing or software vendors for information on their ICD-10 conversion and testing plans. Providers should also look closely at their clinical, financial, billing and coding processes to see how they will be affected by the conversion to ICD-10.

Will the ICD-10 conversion have an effect on provider reimbursement and contracting?

There may be effects. We are evaluating the impact of ICD-10 on our contracting and clinical operations. The ICD-10 conversion is not intended to transform payment or reimbursement. However, it may result in reimbursement methods that more accurately reflect patient status and care.

What is Aetna's approach to mapping ICD-9 codes to the ICD-10 codes?

There is no industry standard for mapping. The Centers for Medicare & Medicaid Services (CMS) has provided General Equivalency Mappings (GEMs) as guidance for mapping between ICD-9 and ICD-10 codes. We are using GEMs as a clinical equivalence tool to remediate business rules between ICD-9 and ICD-10 codes.

Will Aetna use a crosswalk for claims processing?

No. As of the compliance date, standard transactions must be submitted with ICD-10 codes. After that date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the compliance date.

Will Aetna continue to accept ICD-9 codes after the compliance date?

As of the compliance date, standard transactions must be submitted with ICD-10 codes. After that date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the compliance date.

We will continue to follow communications from the regulatory authorities, and will adapt our approach as permitted.

Will Aetna accept the revised CMS HCFA 1500 paper claim form version 02/12?

Yes. As of January 6, 2014, we are accepting the revised form. We will continue to accept and process paper claims submitted on the CMS HCFA 1500 paper claim form version 08/05. The revised HCFA 1500 paper claim form version 02/12 supports various coding requirements and prepares for the conversion to ICD-10 diagnosis coding.

Next Step

For more information on ICD-10 implementation

These industry resources may help with your planning and preparation:

Centers for Medicare & Medicaid Services
Workgroup for Electronic Data Interchange

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