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ICD-10 Basics

Meaningful Help for “Meaningful Use”

ICD-10 Deadline – October 1, 2015

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10. Below is background and additional information on the ICD-10 transition and general guidance on how to prepare for it.

About ICD-10

ICD-10 (International Classification of Diseases, 10th Edition) consists of two parts:

ICD-10-CM (Clinical Modification) for diagnosis

ICD-10-PCS (Procedure Coding System) for inpatient

  • ICD-10-CM is for all US healthcare settings
  • ICD-10-PCS is for US inpatient hospital settings only
  • Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
  • ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9

 

Note: The transition to ICD-10 is occurring because ICD-9 is 30 years old and provides limited data about patients’ medical conditions and hospital inpatient procedures. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

Who Needs to Transition

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The change to ICD-10 does not affect CPT coding for outpatient procedures. Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10, which means:

  • All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
  • ICD-10 diagnosis codes must be used for all health care services provided in the U.S., and ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid. Healthcare providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10.
  • ICD-10-CM for diagnosis coding ICD-10-PCS for inpatient procedure coding ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar. ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9- CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

Transitioning to ICD-10

It is important to prepare now for the ICD-10 transition. The following are steps you can take to get started:

  • Providers – Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 transition efforts.
  • Payers – Review payment policies since the transition to ICD-10 will involve new coding rules. Ask your software vendors about their readiness plans and timelines for product development, testing, availability, and training for ICD-10. You should have an implementation plan and transition budget in place.
  • Software vendors, clearinghouses, and third-party billing services – Work with customers to install and test ICD-10 ready products. Take a proactive role in assisting with the transition so your customers can get their claims paid. Products and services will be obsolete if steps are not taken to prepare.