Circular no. 5 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 Namaf has circulated. 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. Approximately 74% of software vendors have indicated that their software systems comply with the phase 2 ICD-10 requirements. Healthcare providers are healthcare are requested to communicate with software vendors to ensure compliance with their practices.
A meeting was convened with administrators on 05 February 2025 and administrators were requested to update their claims systems with the ICD-10 MIT and to enhance claims systems to comply with the phased requirements of ICD-10. It must be noted that during upgrades of systems, stakeholders must comply with the following requirements as per the ICD-10 Technical User Guide:
Practice Management Software Systems: to cater for ICD-10 codes at a line-item level, 1 primary and 9 secondary codes per line.
Hospitals Systems: to cater for ICD-10 codes at a header level, 1 primary and 19 secondary codes.
Administrator systems: to cater for both formats.
2.2. ICD-10 Task Team
The first ICD-10 Task Team meeting took place on 13 February 2025. There was good representation and participation from stakeholders at the meeting. The Task Team will consist of a main committee that will be the decision-making body with a chairperson and a co-chairperson and two sub-committees, i.e., a Privacy and Confidentiality subcommittee and an ICD-10 Morbidity sub-committee. The sub-committees will be working committees and will be open to all healthcare stakeholders. Stakeholders were requested to submit names of representatives to participate in sub-committee meetings. Names were submitted to Namaf, Namaf will collate the names and communicate further with stakeholders. The sub-committees will be formalised at the next meeting, chairpersons and co-chairpersons will be elected for each of the sub-committees. The sub-committees will be responsible for consultation with appropriate stakeholders, conducting research where appropriate and recommending standards or guidelines. The standards and guidelines will be presented to the main committee that will be responsible for the adoption and sign-off of the standards and guidelines. Furthermore, the main committee will be responsible for compliance and monitoring of the ICD-10 implementation. Namaf will communicate details of future Task Team meetings.
2.3. ICD-10 Webinars, Workshops and Training
ICD-10 webinars and workshops will commence in February 2025, and ICD-10 training will commence in March 2025. 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.
