ICD-10 FAQ

How would the 1-year delay affect your planning?

We will maintain our current momentum on our ICD-10 program work, including remediation of our impacted systems and vendor tools, affected business processes and policies. We plan to be fully ready to process ICD-10 claims by 10/1/2014.

Would a delay affect your ability to be ready to test with early adopters?

We will keep providers informed about our progress on the ICD-10 conversion, including timelines and testing. We plan to conduct targeted testing and will contact directly those entities involved.

What is Aetna’s position on the final rules?

We plan to meet all applicable timeframes for compliance and will work closely with providers and clearinghouses as they strive for compliance as well.

We believe the more detailed coding is helpful and brings the United States in line with non-U.S. practices. The ICD-10 codes allow for more accurate information to accompany a claim, which will allow for more accurate claims payment and coverage decisions.

What is Aetna doing to prepare for the ICD-10 conversion?

We have engaged the impacted areas of our company in business assessments and planning for the move from 18,000 ICD-9 codes to more than 140,000 ICD-10 codes. We developed a multi-year roadmap which incorporates system design and development, development of business processes and policies, communication and training for affected constituencies.

We are working together with the medical community to share information and minimize disruption related to ICD-10 conversion. We also work across the industry, collaborating with AHIP in a consortium focused on addressing challenges related to transition and implementation. We will continue to align ourselves with CMS direction and will look for opportunities to provide input on the ICD-10 conversion.

What should physician practices and facilities do to prepare for the new October 1, 2014* ICD-10 compliance date?

The October 2014* compliance date may seem far off, but the complexity of conversion requires immediate and ongoing action to address the business and clinical issues associated with the transition. The ICD-10 conversion will affect nearly all provider systems and many processes. The largest impacts will likely be in clinical and financial documentation, billing and coding.

It is critical not to delay planning and preparation. It is important that providers contact their billing or software vendor to understand their plans for conversion and testing.

Will Aetna conduct ICD-10 testing with providers?

We will keep providers informed about our progress on the ICD-10 conversion, including timelines and testing. We plan to conduct targeted testing and will contact directly those entities involved.

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

We are evaluating what the impact of ICD-10 will be on our contracting and clinical operations. We do believe the transition from 18,000 codes to 140,000 codes will have an impact on the entire industry. Mappings between ICD-9 and ICD-10 identify corresponding diagnosis codes between the two code sets It is important to note, the ICD-10 conversion was not intended to transform payment or reimbursement. However, it may result in reimbursement methodologies that more accurately reflect patient status and care.

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

Mappings between ICD-9 and ICD-10 identify corresponding diagnosis codes between the two code sets.¹ CMS has provided General Equivalency Mappings (GEMs) as an approach to define reasonable alternatives for mappings between ICD-9 and ICD-10 codes in both directions. While the GEMS provide guidance and a starting point for crosswalk development, there is currently no industry standard for mapping. We are evaluating the GEMs to determine how they can be applied to our practices, including reviewing common claim scenarios for simulation and modeling.

Will Aetna support dual intake of codes?

We plan on meeting all applicable timeframes for compliance. We expect providers and clearinghouses that we work with will meet those timeframes as well. However, we are prepared to operate in a dual environment – accepting both ICD-9 and ICD-10 codes – for a period of time after the October 1, 2014* compliance date in order to accommodate claims with dates of service (outpatient) or dates of discharge (inpatient) prior to 10/1/2014*. We will continue to closely follow the communications from the regulatory authority and will adapt our approach as permitted.

*Subject to a 30-day comment period.

Where can I find additional information on ICD-10?

There are additional industry resources available to assist you in your planning and preparation:

• Centers for Medicare & Medicaid Services (CMS)
• Workgroup for Electronic Data Interchange (WEDI)