Circular no. 3 of 2024
- Published by NAMAF
ICD-10 Coding Implementation Update
1. Background
Circular 1 of September 2024 made mention that NAMAF was conducting a readiness assessment. Further assessment included the analysis of ICD-10 codes from claims data obtained from all four administrators. In addition, a practice management software (PMS) vendor survey was conducted through the practices to establish if software systems were compliant to the phase 2 implementation requirements.
2. Implementation Update
The findings from the second assessment revealed an overall compliance rate of 55% and the findings were similar to those of assessment 1. Findings from the PMS vendor survey suggest that not all vendors are compliant to the phase 2 ICD-10 requirements. The assessment findings and the PMS survey has revealed that the private healthcare industry is not ready for the next phase of ICD-10 implementation on 01 January 2025. To this end, Namaf convened a special Management Committee (MC) where the findings of the assessments and the survey were presented to the MC together with a proposal for a phase approach to the ICD-10 implementation. The MC accepted the proposal and the phased approached to the implementation is outlined below:
Phase1: is the current phase that is in effect and this phase will remain in place until 31 March 2025. Namaf encourages all healthcare providers to submit ICD-10 codes on all claims. Administrators may not reject any claims due to ICD-10 non-compliance. PMS systems, hospital billing systems and administrator claims systems need to be enhanced during this phase to accommodate the ICD-10 Master Industry Table (MIT). To assist with the updates, an ICD-10 Technical User Guide is available on Namafs website. This user guide provides instructions regarding the ICD-10 requirements for each of the phases. Training, workshops, and webinars will continue during this phase and Namaf will continue to send out ICD-10 implementation update circulars. An ICD-10 Implementation Task Team will also be established during this phase by Namaf to enable all healthcare stakeholders to participate in the implementation process.
Phase 2.1: will come into effect on 01 April 2025 and will end on 30 June 2025. No claims rejections due to ICD-10 non-compliance will take place during this phase. It is anticipated that all PMS, hospital and administrator billings and claims system are compliant with the ICD-10 MIT requirements. This
means that the ICD-10 MIT will be utilised to select ICD-10 codes by providers. Administrators are required to validate the ICD-10 codes against the ICD-10 MIT and send messages to providers informing them of the level of compliance. Training, workshops, and webinars will continue during this phase and Namaf will circulate relevant circulars.
Phase 2.2: will come into effect on 01 July 2025 and will end on 30 September 2025.This phase will entail a mandatory submission of at least one 3-character ICD-10 code on a claim by all healthcare providers. Multiple and ICD-10 coding up to the correct level of specificity is encouraged during this phase. A “no ICD-10 code – no pay” principle will apply during this phase. All ICD-10 codes assigned to claims must be selected from the ICD-10 MIT. Administrators are requested to conduct claims validation against the ICD-10 MIT for correctness of the ICD-10 codes. Submission of either the referral diagnosis from the diagnosing provider, a sign or symptom code or a code from chapter XXI (Z codes) for non-diagnosing providers is encouraged.
Healthcare stakeholders are requested to contact Namaf for assistance with the implementation of ICD-10.
