ICD-10
01 » The ICD-10 Transition:
AN INTRODUCTION
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ICD-10 DEADLINE
OCT 1, 2015
T
he ICD-9 code sets used to report medical diagnoses
and inpatient procedures will be replaced by ICD-10
code sets. This fact sheet provides background on the
ICD-10 transition, general guidance on how to prepare
for it, and resources for more information.
»
About ICD-10
01 ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/
Procedure Coding System) consists of two parts:
ICD-10-CM ICD-10-PCS
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for diagnosis for inpatient
coding procedure coding
ICD-10-CM is for use in all U.S. health ICD-10-PCS is for use in U.S. inpatient
care settings. Diagnosis coding under hospital settings only. ICD-10-PCS uses
ICD-10-CM uses 3 to 7 digits instead of 7 alphanumeric digits instead of the 3
the 3 to 5 digits used with ICD-9-CM, but or 4 numeric digits used under ICD-9-
the format of the code sets is similar. CM procedure coding. Coding under
ICD-10-PCS is much more specific and
substantially different from ICD-9-CM
procedure coding.
The transition to ICD-10 is occurring because ICD-9 produces limited
data about patients’ medical conditions and hospital inpatient
procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current
medical practice. 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
Health care by the Health Insurance Portability and Accountability Act (HIPAA), not just those
providers, payers, who submit Medicare or Medicaid claims. The change to ICD-10 does not affect
CPT coding for outpatient procedures.
clearinghouses, and
Health care providers, payers, clearinghouses, and billing services must be prepared
billing services must to comply with the transition to ICD-10, which means:
be prepared to comply l All electronic transactions must use Version 5010 standards, which have
with the transition to been required since January 1, 2012. Unlike the older Version 4010/4010A
ICD-10. standards, Version 5010 accommodates ICD-10 codes.
l 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.
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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:
l Providers – Develop an implementation strategy that includes an assessment of the
impact on your organization, a detailed timeline, and budget. Check with your billing
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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.
l 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.
l 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.
ICD-10 Resources
There are many professional, clinical, and trade associations offering ICD-10
information, educational resources, and checklists. Call or check the websites of your
associations and other industry groups to see what resources are available.
www.cms.gov/ICD10
The CMS website has official resources to help you prepare for ICD-10.
CMS will continue to add new tools and information to the site throughout
the course of the transition.
Sign up for ICD-10 Email Updates
Follow @CMSgov on Twitter for the latest news and resources.
Last Updated: August 2014 -3-
