ICD-10: 10 Questions, 10 Answers

By Shelly Guffey and Dawn Duchek

You have probably completed your transition to 5010, but don’t get too comfortable! The next major transition, to the new ICD-10 coding system, is coming, and it is going to be bigger than 5010. Even though ICD-10 won’t take effect until October 1, 2013, practices should start preparing now to avoid reimbursement issues in the future.

Recently, we presented a webinar with AAPC to inform practices how ICD-10 will impact the way they do business. When we received nearly 400 questions from attendees at that webinar, we realized there is still a lot of confusion about what ICD-10 is, why we have to make the switch, and what changes practices will have to adopt internally to be compliant.

Here are answers to the ten most common questions we’ve received:

1. What is ICD-10?
International Classification of Diseases (ICD) codes are alphanumeric designations that providers assign to every medical diagnosis and description of symptoms for patients. ICD-10 is the 10th updated edition of these codes, which will replace the United States’ current ICD-9 system.

2. Why are we changing to ICD-10?
There are multiple reasons for the change to ICD-10. The United States is the only country that currently is still using ICD-9, and the switch to ICD-10 will allow us to compare our healthcare data more accurately with other countries. ICD-10’s more expansive system will also help us better track data to measure the quality and safety of care, process claims for reimbursement, and improve clinical, financial and administrative performance.

3. When will we begin using ICD-10?
Code set usage will depend on whether you are submitting an inpatient or outpatient claim. If you are billing outpatient claims you will use ICD-9 for dates of service prior to October 1, 2013 and ICD-10 for services on October 1, 2013 and forward. For inpatient claims, the code set will be based on the discharge date.

4. Is there a grace period before ICD-10 goes into full effect?
The final rule to implement ICD-10 came out in January 2009, which gave us more than four years to prepare for the transition. At this time, there are no plans for an additional grace period.

5. Is the switch to ICD-10 just for Medicare and Medicaid, or are other insurance companies changing too?
HIPAA mandates that all insurance plans in the United States make the transition to ICD-10 as of October 1, 2013.

6. How many codes will there be in ICD-10?
ICD-10 will include 140,000 codes, while ICD-9 is made up of only 17,000 codes. The addition of more codes will allow practices to more specifically report the care they provide to patients on their claims.

7. Can I see the ICD-10 code sets before 2013, and where can I find them?
The ICD-10-CM and ICD-10-PCS code sets are available now free of charge and can be found on the CMS website (www.cms.gov/icd10).

8. If we have the ICD-10 codes, can we start using them now?
ICD-10 code sets cannot be used until October 1, 2013. You will need to continue using ICD-9 until that date.

9. Why should I start preparing now for the ICD-10 transition when it doesn’t happen until October 2013?
The transition to ICD-10 is a major undertaking for providers, payers and vendors. It will drive business and systems changes throughout the health care industry, from large national health plans to small provider offices, laboratories, medical testing centers, hospitals and more. To ensure a smooth transition, these organizations need to devote staff time and financial resources to transition activities. So, it’s best to develop a transition plan now and start preparing your staff. A successful transition to ICD-10 will be vital to transforming our nation’s health care system and ensuring uninterrupted operations.

10. What type of training will providers and staff need for the ICD-10 transition?
Training needs will vary for different organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding. You and your staff should take advantage of specialty-specific ICD-10 training offered by societies and other professional organizations.

CMS and coding associations, such as AAPC, have resources to help providers prepare for a smooth transition to ICD-10. These organizations will continue to add new tools and information to their sites through the course of the transition, so visit regularly to access the latest information and training opportunities.

Shelly Guffey is the manager of premier accounts and vendor partners at Gateway EDI. Dawn Duchek is the industry initiatives coordinator for Gateway EDI. For a compilation of key industry resources on ICD-10, visit http://www.gatewayedi.com/icd10/.