Gateway EDI

Healthcare providers trust Gateway EDI's complete support system of people and tools to maximize their revenue and increase cash flow.

More than 200,000 providers trust Gateway EDI's medical claims processing solutions to simplify claims reimbursement and revenue management. We offer electronic claims processing, real-time eligibility verification, point-and-click access to identify and recover missing revenue, automated secondary claims and electronic remittance advice and tools that ease patient payment collection.

Gateway EDI began in 1983 with one idea: to streamline medical practice operations. Today, we're one of the fastest-growing Electronic Data Interchange (EDI) clearinghouses in the country.

Of course, much has changed in claims processing and office operations. But we're committed as ever to giving our clients the latest tools and technology they need to tackle the revenue challenges they face today - and will face tomorrow.

What can I do to prepare for ICD-10-CM?

• Start early. Physicians, coders and other health care personnel will need significant education and training in order to complete full implementation of this major code change.
• Prepare for clerical changes. The ICD-10 set will include changing alphanumeric codes and restructuring chapters or categories of the current ICD book.
• Prepare for detail expansions. Along with clerical changes, the ICD-10 set may expand the detailing of conditions to accommodate more specific varieties of illness and injury.
• Talk to colleagues and any partners who use ICD codes. Discuss how the ICD-10 codes will affect different types of care, from inpatient and outpatient visits to psychological care, home health care, and drug and alcohol services.

Will ICD-10 affect the Current Procedural Terminology (CPT) codes for physician services?

No. Current Procedural Terminology (CPT) will remain the coding system for physician services.

Why is the United States moving to ICD-10-CM?

ICD-9-CM first and foremost is out of space for meeting current and future requirements. Because the classification is organized scientifically, each three-digit category only holds up to 10 subcategories and most numbers in the categories have been assigned diagnoses. As medical science continues to make new discoveries, there are no number categories available to assign the associated diagnoses.

In addition, more detailed coding is available in ICD-10-CM to enable better analysis of disease patterns and treatment outcomes. This improvement can aid in advancing U.S. medical care, as well as streamlining claims submissions by making the initial claim much easier for payers to understand the services provided.

When will ICD-10-CM and ICD-10-PCS be implemented?

The implementation date for all ICD-10 codes is October 1, 2014, however transition plans need to factor in related changes that precede this deadline. These include the implementation of the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions such as health care claims. Version 5010 is essential for use of the ICD-10 codes.

How will codes be different with ICD-10?

While the current ICD-9 codes are mostly numeric, the new ICD-10 codes will be alphanumeric, beginning with a letter and include a mix of numbers and letters thereafter. ICD-9 lacks the space and flexibility demanded by the growing number of diagnoses from medical advancements and an increased need for specificity. By allowing for greater specificity, claims will contain better documentation of severity and better analysis of disease patterns and treatment outcomes.

What is ICD-10?

ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. The U.S. clinical modification of ICD-10, ICD-10-CM, is the code set scheduled to replace ICD-9-CM, our current U.S. diagnostic code set. This change also includes ICD-10-PCS, for the "procedural coding system," which will also be adopted in the United States and will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system.

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