Circular no. 4 of 2025
- Published by NAMAF
ICD-10 Coding Implementation Update
1. Background
In December 2024, NAMAF communicated that Phase 2.1 will be implemented on 01 April 2025 and will remain in effect until 30 June 2025. During this phase providers of healthcare will be required to submit ICD-10 codes from the ICD-10 Master Industry Table (MIT).
No rejections of claims will occur in this phase; however, administrators will be required to send messages to providers informing them of the level of provider compliance.
The December 2024 circular also mentioned that Phase 2.2 will be implemented on 01 July 2025 and will remain in effect until 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 ICD-10 coding 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.
2. Preparation for the Phased Implementation of Phase 2.1 and Phase 2.2
2.1. Software Enhancement and Upgrade
In preparation for the implementation of phases 2.1 and 2.2, all healthcare stakeholders are required to enhance and upgrade billing and claims systems as per the ICD-10 Technical User Guide that has been circulated by NAMAF. The ICD-10 MIT must be incorporated into all billing and claims systems. Assignment of ICD-10 codes by providers and ICD-10 validation of claims by administrators must be done from the ICD-10 MIT. NAMAF is communicating with software vendors and administrators to establish the level of readiness and assist where necessary.
2.2. ICD-10 Task Team
NAMAF is in the process of establishing an ICD-10 Task Team to streamline the implementation of ICD-10. All healthcare stakeholders are required to participate in the ICD-10 Task Team and names of representatives from each organisation must be submitted to NAMAF. The closing date for submissions of names is 30 January 2025. The date of the first ICD-10 Task Team meeting will be communicated by NAMAF before the end of January 2025.
2.3. ICD-10 Webinars, Workshops and Training
ICD-10 webinars, workshops and training will continue. Details of the webinars, workshops and training sessions are available on the NAMAF website.
3. Conclusion
Healthcare stakeholders are requested to contact NAMAF for assistance with the implementation of ICD-10.
