7 Things You Need to Know Now About ICD 10 Codes

By Charlotte Bohnett

The massive ICD 10 change is quickly approaching, and it affects all of us in the healthcare field. Thus, there is no time like the present to start your ICD 10 education. Here are the seven things you need to know now about ICD 10 codes.

1. ICD-10 will replace ICD-9

In a little over a year, you will no longer report the diagnosis codes you know as ICD 9, which are code sets consisting of three to five characters with a decimal point (e.g., 813.15). Instead, you will use International Classification of Diseases, 10th Revision (ICD 10), which uses three to seven characters in an alpha-numeric combination. In addition to a different code structure, there are about five times as many ICD 10 codes as ICD 9 codes. This will ensure an intense level of specificity in coding diagnoses.

2. The change is necessary

The United States is the last country in the world with modern healthcare to adopt ICD 10  codes. But playing catch up isn’t the only reason why shifting to ICD 10 is necessary. According to a CMS ICD 10 introduction, the U.S. must transition to ICD 10 because it:

• Produces limited data about patients’ medical conditions and hospital inpatient procedures.
• Is 30 years old, has outdated terms and is inconsistent with current medical practice.
• Limits the number of new codes that can be created, and many ICD 9 categories are full.

3. The change is mandatory

According to a CMS ICD 10 FAQ document, “Claims for all healthcare services and hospital inpatient procedures performed on or after Oct. 1, 2014, must use ICD-10 diagnosis and inpatient procedure codes. … Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed.”

Translation: You won’t get paid for any claims of services after Oct. 1, 2014, if you use ICD 9 codes. Alternatively, payers will not accept ICD 10 codes for payment before the implementation date. Thus, “claims for services provided before Oct. 1, 2014, must use ICD 9 diagnosis and inpatient procedure codes,” says the FAQ.

4. The start date is Oct. 1, 2014

ICD 10 goes into effect on Oct. 1, 2014. That means — to emphasize the point made in number three — you will use ICD 9 diagnosis codes for all claims of service until Sept. 30, 2014. The next day, you’ll use ICD 10 — and there will be no extension. Oct. 1, 2014, is implementation day — period.

5. ICD-10 will not replace CPT codes

ICD 10 codes are diagnosis codes. CPT codes are billing codes. Both go on your claim. Per the CMS ICD-10 FAQ document, “The transition to ICD 10 does not affect CPT coding for outpatient procedures. … Like ICD 9 procedure codes, ICD 10-PCS codes are for hospital inpatient procedures only.”

6. ICD 10 does affect you

I know I’m quoting CMS a lot here, but ICD 10 affects everyone covered by HIPAA — not just those who submit Medicare or Medicaid claims. Thus, ICD 10 affects all anesthesiologists as well as all other providers, payers, clearinghouses and billing services. In short, if you deal with HIPAA, buckle up because you’re switching to ICD 10.

7. You need to start preparing

The idea of readying yourself for this change can seem more than overwhelming. Hello, 68,000 diagnosis codes! But the earlier you start, the more time you’ll have to get all your ducks in a row. Here are some pointers:

• Develop an implementation strategy. Make sure you assess the impact on your organization, develop a detailed timeline and plan a budget.
• Check with your billing service, your clearinghouse and all of your vendors about their implementation and compliance plans. If you handle billing internally, make sure your coding, clinical, IT and finance staff are involved in the planning of and preparation for your practice’s or facility’s transition.
• abeo is actively working to implement ICD 10 with its clearinghouses and other vendors by the October 2014 deadline. abeo will be providing training meetings to ensure that your practice is ready

For more preparation advice, check out No. 11 in this CMS ICD 10 FAQ document and review this detailed planning and preparation checklist from the American Health Information Management Association.

Charlotte Bohnett is a writer, content manager and social media expert for WebPT, a cloud-based electronic medical record (EMR) solution designed specifically for the rehab community. She graduated summa cum laude from Bowling Green State University with a Bachelor of Fine Arts in Creative Writing. Charlotte earned her Master of Science in Technical and Professional Communication from Lawrence Technological University in Southfield, Mich.