ICD-10 IMPLEMENTATION PROJECT

 

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) published the final rule to adopt ICD-10 as the HIPAA standard code sets for diagnosis and procedure codes to replace ICD-9.  A second notice was issued August 24, 2012, modifying the compliance date from October 1, 2013 to October 1, 2014. 

The International Classification of Diseases, 10th Edition consists of two parts:

1.       ICD-10 CM (Clinical Modification) for diagnosis coding

2.       ICD-10 PCS (Procedure Coding System) for inpatient procedure coding

ICD-10 CM will be used in all U.S. health care settings and uses 3 to 7 alphanumeric characters as opposed to 3 to 5 digit codes used by ICD-9 CM.  ICD-10 PCS uses 7 alphanumeric digits rather than 3 to 4 numeric digits and is more specific.

 

ICD-10 will affect diagnosis and inpatient procedure coding for all HIPAA covered entities including Healthcare Providers, Billing Agents/Clearinghouses, and Health Plans.  The transition to ICD-10 code sets will require business and system changes throughout the health-care industry.  All Providers that are covered by HIPAA must make the transition by the compliance date.

Reasons ICD-9 is being replaced:

1.       Produces limited data about patients’ medical conditions and inpatient hospital procedures.  ICD-10 will enhance the measurement of quality of care through the assignment of more specific codes.

2.       Outdated terms that are inconsistent with current medical treatment and technology; the number of new codes that can be created is limited and majority of the categories are full and do not reflect advanced technology and care delivery available today.  ICD-10’s granularity will enhance clinical decision-making, allow us to better track public health issues, and ensure accurate payment for services rendered.

For dates of service and dates of discharge prior to October 1, 2014, the claim must use ICD-9 codes.  For dates of service and dates of discharge on or after October 1, 2014, claims must contain ICD-10 codes.  Claims will be rejected if an invalid diagnosis or procedure code is submitted after the compliance date.

ICD-10 will impact your reimbursements, so it is important to start preparing for the transition to ICD-10 codes.

This page will be updated throughout the ICD-10 implementation process to ensure it contains the most up-to-date information.  Providers and submitters are encouraged to visit this page often for important updates.

 

Correspondence (COMING SOON)

FAQs (COMING SOON)

Federal Registers

News/Updates (COMING SOON)

Resources

The Centers for Medicare & Medicaid (CMS) provides extensive information for providers, payers and vendors, including fact sheets, tools, timelines and resources for implementing ICD-10.

CMS ICD-10 Introduction

CMS ICD-10 Frequently Asked Questions

CMS General Equivalence Mappings (GEMs): GEMs are mappings between ICD-10-CM and PCS and ICD-9-CM codes, designed to assist in converting applications and systems from ICD-9 to ICD-10.

CMS ICD-10 Industry Email Updates

Provider Resources: CMS resources to assist providers in the transition to ICD-10

                Vendor Resources: CMS Resources to assist vendors in the transition to ICD-10

American Health Information Management Association (AHIMA)

Workgroup for Electronic Data Interchange (WEDI) provides a broad-based interactive forum for healthcare executives, managers, and advisors to utilize in addressing the business issues and policy formulation for the industry.

Other Helpful Resources:

The American Academy of Professional Coders (AAPC) provides education and professional certification to physician-based medical coders and student training, certification, ongoing education, and networking.

Centers for Disease Control (CDC) ICD-10-CM

Healthcare Information and Management Systems Society (HIMSS)

ICD-10 Monitor

WHO ICD Web Site: The World Health Organization (WHO) provides links and downloads to help better understand ICD coding and the transition from ICD-9 to ICD-10.