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What is ICD-10?

ICD-10 stands for International Classification of Diseases, 10th Revision, Clinical Modification and is based on the World Health Organization’s (WHO) 10th revision of the International classification of diseases.

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

ICD-9 ICD-10
3-5 Characters 3-7 Characters
13,000 codes 14,400 codes that can expand to 16,000 through use of sub-codes
Limited space for adding new codes Easily expandable for adding new codes
Lacks detail Very Specific

What is the compliance date for ICD-10?

All services and discharges on or after October 1, 2014 are required to use the ICD-10 diagnosis and procedure codes. ICD-9 codes will no longer be compliant and will be rejected by the clearinghouses and health plans.

Will ICD-10 be delayed again?

The Center for Medicare & Medicaid Services (CMS) has repeatedly stated that regardless whether small practices and other systems may not be ready there will not be another delay in the implementation date of ICD-10. Further, Medicare is on target to upgrade to ICD-10 and is expected to be ready by the deadline.

Who has to upgrade to ICD-10?

All HIPAA “covered entities” will have to convert to ICD-10 as it is a HIPAA code set requirement. This means providers, including physicians, which are HIPAA covered entities must comply with this requirement. It is important to note, however, that claims for services provided before October 1, 2014, must use ICD-9 diagnosis and inpatient procedure codes.

What is the difference between ICD-10-CM and ICD-10PCS?

There are 2 ICD-10 code sets. ICD-10-CM is the International Classification of Diseases, Clinical Modification relates to diagnosis coding. All healthcare providers will use ICD-10 for diagnosis coding. ICD-10-PCS is International Classification of Diseases, Procedure Coding System. Only facilities will be using ICD-10-PCS to report inpatient procedures. Physician practices will continue to use CPT codes to report their performed services.

Why replace ICD-9?

The ICD-9 code set has become outdated in the over 30-years that it has been in use. ICD-9 simply does not reflect advances and changes in medical technology and the format limits the ability to expand the code set as needed.

Can I convert to ICD-10 before the deadline?

CMS guidelines require the use of the ICD-9 codes until the October 1, 2014 effective date. Using ICD-10 for claims prior to the effective date will violate CMS current guidelines.

What will happen if I am not ready by the ICD-10 effective date?

Any ICD-9 codes used in claims transactions for services or discharges that occur any day after October 1, 2014 will be rejected as non-compliant and these transactions will not be processed. Your transactions process will be disrupted as well as receipt of your payments.

What do I need to do to prepare for ICD-10?

  • First get in touch with Billing Gurus. We can assist you in your preparations for ICD-10.
  • Identify what changes you will need to make within your practice to convert to the new code set.
  • Identify what staff will require training and obtain training for those that need it.