Circular no. 6 of 2025
- Published by NAMAF
1. ICD-10 Coding Implementation Update
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,, healthcare providers 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 to check for the correctness of the ICD-10 codes submitted. 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.
Actions Required:
1.
Healthcare providers are required to start submitting ICD-10 codes from the ICD-10 Master Industry Table (MIT) as of April 1, 2025.
2.
Administrators need to send compliance messages to providers regarding their ICD-10 submission levels.
3.
From July 1, 2025, all healthcare providers must include at least one 3-character ICD-10 code per claim to ensure payment.
4.
Administrators should validate claims against the ICD-10 MIT to check for correctness.
2. Preparation for the Phased Implementation of Phase 2.1 and Phase 2.2
2.1. Software Enhancement and Upgrade
NAMAF has engaged with software vendors and administrators. Positive feedback has been received from software vendors and administrators, most of whom have indicated in writing that their software and IT systems are compliant with the requirements for phase 2.2 of the ICD-10 implementation. NAMAF is communicating further with software vendors and administrators who are not fully compliant. Healthcare stakeholders are once again reminded to consult the ICD-10 Technical User Guide and take note of the ICD-10 requirements at a claim level, i.e.
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Practice Management Software Systems: to cater for ICD-10 codes at a line-item level, one primary and nine secondary codes per line.
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Hospitals Systems: to cater for ICD-10 codes at a header level, one primary and 19 secondary codes.
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Administrator systems: to cater for both formats. Actions Required:
1.
Healthcare providers and institutions should ensure their Practice Management Software and Hospital Systems comply with ICD-10 requirements.
2.
Administrators are required to ensure their systems can process ICD-10 codes according to the required format.
3.
Not yet fully compliant stakeholders are encouraged to engage with NAMAF to ensure software and IT systems meet ICD-10 standards.
4.
All stakeholders need to consult the ICD-10 Technical User Guide for system requirements.
2.2. ICD-10 Task Team
An ICD-10 task team has been established, and two meetings have taken place thus far. The first ICD-10 Task Team meeting took place on 13 February 2025,, and the structure, terms of reference, functions, and member representation were discussed. The second task team meeting took place on 10 March 2025. As new members attended the meeting, the structure, terms of reference, functions and task team member representation was again discussed. The chairperson of the main task team, Mr Stephen Tjiuoro, was introduced, and the chair and co-chairpersons of the ICD-10 Morbidity and the Privacy and Confidentiality sub-committees were elected. Each sub-committee was allocated tasks which will be addressed in subsequent meetings. The full constituent of the main task team and future meeting dates will be announced at the next task team meeting in April 2025.
Action Required:
1.
Healthcare stakeholders should note that an ICD-10 Task Team has been established to oversee implementation.
2.
Subcommittee members are expected to actively participate in meetings and complete assigned tasks.
3.
Task team members should prepare for the April 2025 meeting, where final composition and future meeting dates will be announced.
2.3. ICD-10 Webinars, Workshops and Training
To create awareness and an understanding of ICD-10, several ICD-10 webinars and workshops were conducted in February and March 2025. These will continue during March and April 2025. All healthcare stakeholders are requested to attend the webinars and workshops.
2.3.1.Webinars
Webinars offer general information about the , implementation of ICD-10
2.3.2. Workshops
Workshops are more focused on ICD-10 requirements per provider discipline type. Workshops also introduce healthcare stakeholders to the structure, principles and rules of ICD-10.
2.3.3. Training
The applications of the ICD-10 rules, the assignment of ICD-10 codes, and the use of the coding standards document are discussed in ICD-10 training sessions. For correct assignment and interpretation of ICD-10 codes, healthcare stakeholders are requested to attend the one-day ICD-10 training sessions. Action Required:
1.
All healthcare stakeholders are encouraged to attend upcoming ICD-10 webinars and workshops in March and April 2025.
2.
Providers should attend discipline-specific workshops to understand the ICD-10 requirements for their field.
3.
Healthcare stakeholders are advised to register for ICD-10 training sessions to correctly assign and interpret ICD-10 codes.
4.
Details of the training sessions are available on the NAMAF website, and stakeholders are encouraged to check regularly for updates.
3. Conclusion
Healthcare stakeholders are requested to contact NAMAF for assistance with the implementation of ICD-10.
