ICD-10-CM is the International Classification of Diseases, 10th Revision Clinical Modification. This is a new/revised diagnosis classification system developed by the Centers for Disease Control and Prevention (CDC) for use in all United States health care settings. ICD-10-CM will replace the existing diagnosis code set, ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification, Volumes 1 and 2).
You should be planning and taking action now to be compliant by Oct. 1, 2015.
The deadline is Oct. 1, 2015.
ICD-10-CM compliance means that all HIPAA-covered entities must implement ICD-10-CM for use in standard electronic transactions (including but not limited to claims) for health care services provided on or after Oct. 1, 2015.
No. The transition to ICD-10-CM does not affect CPT coding for physician services.
Everyone covered by HIPAA must use ICD-10-CM starting Oct. 1, 2015. This includes health care providers and payers who do not deal with Medicare claims. Organizations that are not covered by HIPAA but use ICD-9-CM codes should be aware that their coding may become obsolete if they do not transition to ICD-10-CM.
If you don’t transition to ICD-10-CM, all your claims for all health care services performed on or after Oct. 1, 2015 will not be processed, therefore risking claims denials. NOTE: Claims for services provided before Oct. 1, 2015, must use ICD-9-CM diagnosis codes.
The health care industry is making the transition from ICD-9-CM to ICD-10-CM because:
ICD-10-CM codes are completely different from ICD-9-CM codes. Currently, ICD-9-CM codes are mostly numeric and have three to five digits. ICD-10-CM codes are alphanumeric and contain three to seven characters. ICD-10-CM is more robust and descriptive with "one-to-many" matches to ICD-9-CM in some instances. Like ICD-9-CM codes are now, ICD-10-CM codes will be updated every year. ICD-9-CM codes will not continue to be updated after Oct. 1, 2015.
ICD-10-CM is not just an update of ICD-9-CM codes. It is a restructuring of the diagnosis classification system with far more alpha numeric codes, expanded code lengths and narrative descriptions allowing for greater granularity. The following table illustrates the key differences:
Number of codes
Practice management systems must be able to accommodate both ICD-9-CM and ICD-10-CM codes until all claims and other transactions for services before Oct. 1, 2015 have been processed and completed. Prompt processing for ICD-9-CM transactions as the transition date nears will help limit disruptions and will limit the time frame when dual code sets need to be used.
Implementation planning for ICD-10-CM should begin immediately if it's not already underway, regardless of the size or function of your practice. ICD-10-CM implementation is not just a billing or Information Systems project because the organizational effect of the transition will be broad and deep. For providers who have not yet started to transition to ICD-10-CM, this timeline provides you with some steps to take now. Some of these activities, such as establishing a transition team and communicating to internal staff, might not be necessary for small practices where one or two people will be handling the transition activities. Ensure an impact assessment is conducted as soon as possible to enable timely planning, development, education, testing, and implementation.
Dermatologists should plan to test their ICD-10-CM systems early to help ensure they will be ready by the compliance date. Plan to test claims, eligibility verification, quality reporting, and other transactions and processes that involve ICD-10-CM codes from beginning to end. It is important to test both within your organization and with your payers and other business partners. Beginning steps in the testing phase include:
No. CMS and other payers will not be able to process claims using ICD-10-CM until the Oct. 1, 2015 compliance date. However, your organization will need to work with your internal team and with business trading partners to test your software systems from beginning to end. This involves testing claims, eligibility verification, quality reporting and other transactions and processes using ICD-10-CM to make sure the new code set can be processed correctly.
The ICD-10-CM code sets and the ICD-10-CM official guidelines are available free of charge on the "2013 ICD-10-CM and GEMs" pages of the CMS ICD-10 website.
No, there is no one-to-one match between ICD-9-CM and ICD-10-CM due to a variety of reasons:
Centers for Medicare and Medicaid Services (CMS) and the Centers of Disease Control and Prevention (CDC) have developed General Equivalence Mappings (GEMs) to show generally equivalent relationships between ICD-9-CM and ICD-10-CM codes. However, the greater granularity and newness of ICD-10-CM compared to ICD-9-CM often result in one-to-many, one-to-none, and sometimes many-to-many mappings in addition to one-to-one mappings. The GEMs are not to be used as a coding source but rather as a coding resource to help you understand the granularity of ICD-10.
A more specific code crosswalk is available here.
The transition from ICD-9-CM to ICD-10-CM will change how you do business. Health care organizations, from large national plans to small provider offices, laboratories, medical testing centers, hospitals, and more will need to devote staff time and financial resources for transition activities. Activities include:
The transition will go much more smoothly for organizations that plan ahead and prepare now. The AAD website has resources to help you prepare.
The experts recommend that training begin no more than six to nine months before the Oct. 1, 2015, compliance deadline. Training needs will vary for different organizations, but it is projected to take 16 hours for outpatient coders. Coders in physician practices will need to learn ICD-10-CM diagnosis coding only. Take into account that ICD-10-CM coding training may be integrated into the CEUs that certified coders must take to maintain their credentials. In addition, some high-level ICD-10-CM training will be required earlier so that staff can conduct testing in 2013. This includes training to learn the new ICD-10-CM systems and understand how the structure and granularity of the ICD-10-CM codes will affect clinical documentation.
The AAD has recorded several webcasts providing practical guidance for the ICD-10-CM transition.
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