Questions? We have some helpful answers.

ICD-10 is scheduled to be implemented on October 1, of this year. Here is some basic information to help you understand and prepare for what’s coming. We’ve also supplied for you a PDF for you to have on file. Download it here.

What is ICD-10 CM? Why was it developed?

ICD-10 CM (ICD-10 Clinical Modifications) is an international health diagnosis coding system developed by the World Health Organization. The purpose of upgrading to ICD-10 CM is to gather more specific health and disease information for better tracking of clinical decision-making and treatment outcomes.

What is the effective date for implementation of ICD-10 CM?

October 1, 2014. Claims submitted after this date must use ICD-10 CM codes. Claims submitted before October 1 should still reflect ICD-9 codes.

Will ICD-10 be postponed?

CMS says that there will be no further delay in implementing ICD-10. The AMA has filed a request to delay, due to the economic impact on physician practices, but at this point, offices should plan on implementation this year.

What is the difference between ICD-9 and ICD-10?

ICD-10 codes are up to 7 alphanumeric digits, while ICD-9 codes are mostly numeric. ICD-10 codes begin with alpha characters, and reflect a greater degree of specificity. The first 3 characters reflect the category of disease, character 4 is the etiology of disease, character 5 is the body part affected, character 6 is the severity of illness or disease, and character 7 is an extension for more specificity.

Who needs to update to ICD-10?

Everyone who is covered by HIPAA is required to use ICD-10 coding. Workers’ compensation payers may not convert to ICD-10 immediately.

How does this affect CPT coding?

CPT coding will remain the same for now. Outpatient physician service billing is not affected by ICD-10, except that diagnosis codes will need to change to ICD-10.

Does ICD-10 coding apply to non-Medicare claims?

Since payers will need to convert to ICD-10 diagnosis codes, it is expected that ICD-9 codes will become obsolete.

What happens if my office is not ready on October 1?

It’s possible that you will not be paid if you don’t bill using the ICD-10 diagnosis codes on October 1, 2014. Medicare will most likely reject claims, and other payers may as well. The best way to start is to determine your top 100-200 codes and convert those in the next few months, and then you’ll be prepared for most activities on October 1.

Will all payers be ready for ICD-10?

According to what’s been published, Medicare will be ready. Other payers have reportedly been testing their own systems for ICD-10 preparedness. Your biller or billing company should have a plan for submitting claims on October 1, 2014, using the new ICD-10 diagnosis codes.

Where can I get more information on ICD-10?

If you are using an electronic medical record system, then your EHR vendor should have begun the system upgrade process with you.

  • Medicare’s website has a lot of ICD-10 information: (click here)
  • For a list of specific steps you should be taking to make sure your practice is ready for ICD-10, download this document: ICD10 Basics for Medical Practices (click here)
  • You can order reference books from the World Health Organization. Make sure to look at Volume 2, which includes the rules for proper use of the codes. Here is a link to online WHO references: (click here)

We will also be providing updated ICD-10 information on our website, www.PhysicianResourceCenter.com, as information becomes available.