ICD-10: Are you Ready for the Phase 3 and Phase 4.1
ICD-10, The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision was implemented in South Africa in 2005 by the National Department of Health (NDoH) and the Council for Medical Schemes (CMS), utilising a phased approach. The implementation of ICD-10 is currently being overseen by a Ministerial ICD-10 Task Team that functions under the auspice of the NDoH. Phases 1 and 2 were implemented in 2005 and phase 3 was introduced in January 2006. Phase 3 needs to be fully implemented on 01 July 2014. This requires coding to be done from the latest version of the ICD-10 electronic file known as the ICD-10 Master Industry Table (MIT) released by the NDoH in March 2013. The implementation date for this file was 01 June 2013. The updated file contains ICD-10 codes that have been discontinued by the World Health Organisation (WHO) and use of these codes will lead to claims rejections, the file also contains many new and modified codes. Medical aids will utilise this file to do claims validations as of 01 July 2014, i.e.
- only codes marked as valid primary diagnosis (PDX) on the MIT, will be accepted as primary diagnosis codes on claims,
- the ICD-10 codes must appear at the correct level of specificity (valid 3, 4 or 5 characters) as reflected in the MIT,
- all codes submitted on the claim will be subject to validations and not just the primary ICD-10 code
- Codes must follow the combination coding rules, i.e. dagger & asterisk codes, sequelae codes, injury and poisoning codes must have the appropriate external cause codes, etc
Phase 4 has been further phased into phases 4.1 and 4.2. Phase 4.1 will be implemented together with phase 3 on 01 July 2014. This phase will entail the validation of age and gender edits and where possible providers of health care will be required to submit morphology codes on all claims that have ICD-10 codes from the neoplasm section (chapter II) of ICD-10. The morphology information will appear on pathology reports and can only be supplied by Pathologists. The MIT will be utilised for the age and gender edits and codes that have age & gender edits have been flagged in the MIT.
It is envisaged that phase 4.2 will be implemented in 2015/2016. Details of phase 4.2.still needs to be finalised by the NDoH and the ICD-10 Task Team. The ICD-10 Task Team has five sub-committees, i.e. Monitoring & Evaluation, Privacy & Security, ICD-10 Morbidity, ICD-10 Mortality and a Training sub-committee. Healthcare stakeholders can attend meetings and participate in all five sub-committees. ICD-10 discussions take place in these meetings and decisions regarding ICD-10 standards and guidelines are also taken in these sub-committee meetings, following which the decisions are taken to the main Task Team meetings, where further discussions take place and standards & guidelines are adopted. These standards and guidelines are then signed off by the Director General of Health at the NDoH and published as National Coding Policy on the NDoH website.
Failure to abide to the phase 3 and phase 4.1 implementation requirements can lead to claims rejections and incorrect health data collection.