ICD-10 Vendor Questionnaire


The icd-10 vendor questionnaire is also known as the Vendor Readiness Survey and is related to International Classification of Diseases (ICD). The icd-10 vendor questionnaire needs to be filled by those vendors only who in one way or the other is handling storage or retrieval of diagnostic information, epidemiological and other clinical activities, compilation of national morbidity and mortality statistics, and helps in the coding of diseases with focus on abnormal findings and external causes.

Sample ICD-10 Vendor Questionnaire:

Name of the Vendor: _____________________________

Name of medical institution: _____________________________

Employer Identification Number (EIN): ______________________________

Social Security Number (SSN): ______________________________

Address (principal business):______________________________________________

City: _____________  State: __________________ Zip: ______________________

Email: _____________________________

Phone Number: ________________________ Fax: ________________________

  • As an icd-10 vendor, how do you plan to accommodate the ICD-10-PCS or/and ICD-10-CM code sets in your application(s)? Please provide a brief description of the same.

_______________________________________________________________________

  • Are there any modifications that you expect in the screen and reporting formats? If yes, then please provide information on the same.

a)      Yes

b)      No

c)      Brief description:___________________________________

  • How do you plan to achieve compatibility in the ICD10 processing and analysis? Please provide the steps.

a)      ___________________________________

b)      ___________________________________

c)      ___________________________________

d)     ___________________________________

e)      ___________________________________

  • Do you feel your application(s) post implementation can easily support the use of both ICD-9-CM and ICD-10-CM/PCS code sets?

a)      Yes

b)      No

  • Do you feel that dual use can be supported for longer durations? If yes, please provide approximate time duration.

a)      Yes

b)      No

c)      Time duration:_________________________

  • Can you mention the important steps that you must perform in order to test as well as implement both ICD-10-CM and ICD-10-PCS code sets?

a)      ___________________________________

b)      ___________________________________

c)      ___________________________________

d)     ___________________________________

e)      ___________________________________

Category: Vendor Questionnaire

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