We’ve officially hit the six-month mark one-year-six-month mark for the mandatory ICD-10 transition on October 1, 2015, and that means it's time to prepare, even with the extension. So, we’re devoting this month’s blog posts and webinar to ICD-10; we want to help you and your practice prepare. Before we get down to brass tacks—and there are a lot of them when it comes to this new code set—let’s get you up to speed. Here is what you need to know now about ICD-10.

1. ICD-10 applies to all HIPAA-covered entities.

As Medical Economics explains, the transition to ICD-10 will impact everyone working in the healthcare continuum—from providers to payers and vendors. However, practitioners have the most to lose, because if they don’t submit claims correctly, they won’t receive payment.

Note that the mandatory switch to ICD-10 does not apply to non-covered entities, such as worker's compensation, disability, and auto insurers. As this ICD-10 Watch article explains, “if the non-covered entities don't want to switch to ICD-10 coding, they don't have to and can require healthcare providers to submit medical claims with ICD-9 codes.” Moral of that story? Check with any non-covered entity your practice works with to verify whether they’re making the switch.

2. October 1, 2015, is the mandatory transition date.

Everyone and their uncle was saying that October 1, 2014, was the mandatory transition date—no ifs, ands, delays, or grace periods about it. And then proposal HR 4302 came along and turned the US on its head. HR 4302 proposed a 12-month delay for a scheduled 24% cut to Medicare physician reimbursements, but it also included a one-year delay to the mandatory ICD-10 transition (moving from October 1, 2014, to October 1, 2015). On Friday, the House of Representatives passed the proposal by voice vote. Today, the Senate voted to pass it. It's now sitting on the President's desk for signature. Of course, we’re on pins and needles. This is a huge change—one that no one, not even CMS or HIMSS, saw coming—and there's no indication that the President will exercise his veto rights.

3. ICD-10 consists of two parts.

ICD-10-CM is for use in all US health care settings; that’s the code set we care about for private practice PT, OT, and SLP. ICD-10-PCS is for inpatient hospital settings only.

4. ICD-9 and ICD-10 differ big time.

To truly understand the differences, let’s refer to this table from the American Medical Association:

ICD-9 ICD-10
3 to 5 characters 3 to 7 characters
~13,000 codes ~68,000 codes
First character may be alpha (E or V) or numeric; characters 2–5 are numeric Character 1 is alpha; characters 2 and 3 are numeric; characters 4–7 are alpha or numeric
Limited space for adding new codes Flexible for adding new codes
Lacks detail Very specific
Lacks laterality Has laterality (i.e., codes identifying right vs. left)
5. It’s a whole new ballgame.

As this page from health system Optum explains, “ICD-10 codes cannot be inserted into the existing processes and business rules used for ICD-9.” While there’s some degree of crosswalking that can occur, there is no direct ICD-10 counterpart for an ICD-9 code, usually because there many more codes, representing a much greater range of specificity, to choose from.

6. It’s a ballgame that’s necessary.

“The transition to ICD-10 is a business-enabled compliance mandate that will provide better data for measuring health care service quality, safety, and the efficacy of care by allowing clinical IT systems to record far more specific and rich diagnostic information,” said Optum. It’ll also facilitate the adoption of electronic health record systems, which hopefully will improve interoperability. Furthermore, the US is the last country in the world with modern healthcare to adopt ICD-10 diagnosis codes. Besides playing catch up, this CMS ICD-10 introduction also notes these reasons for the switch:

  • “ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures.”
  • “ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice.”
  • “The structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.”
7. Time is still of the essence.

Because it’s a whole new ballgame, you must allow ample time to prepare (and heck, we now have ample time). If you haven’t already established a to-do list and transition plan, now is the time to do so. My recommendation? Download our checklist and preparation guide.


What questions do you have about ICD-10? What ICD-10 topics would you like us to cover this month? Share your feedback in the comments section below.

WebPT + Billing Software - Regular BannerWebPT + Billing Software - Small Banner
  • ICD-10: Fact or Fiction Image

    articleApr 3, 2014 | 5 min. read

    ICD-10: Fact or Fiction

    As with any major change, the rumor mill churns at a mighty pace. With all the hearsay, telephone games, and disbursement of misinformation, it’s easy for the myths to swallow the truth. No worries, though; we’re here to sort the fact from the fiction. Fiction: Coders will spend an overwhelming amount of time dealing with external cause codes. Fact: From being struck by an orca to getting injured while crocheting, Chapter 20 of the ICD-10-CM Manual , …

  • Preparing for ICD-10 Image

    webinarApr 29, 2014

    Preparing for ICD-10

    At the end of March, Congress passed legislation that delays the mandatory transition to ICD-10 until October 1, 2015. With all that extra time, some of you might be eager to push the new code set to the back of your mind. Au contraire! Even though we now have a year and six months until the US goes live with ICD-10, there’s still a lot to be done—and we’re here to help. In this month’s webinar, we’ll …

  • Compliance Expert Tom Ambury Talks ICD-10 Image

    articleApr 10, 2014 | 3 min. read

    Compliance Expert Tom Ambury Talks ICD-10

    Everyone has been gearing up in preparation of the October 1, 2014, ICD-10 implementation deadline. (Even CMS changed their claim form requirements: beginning on April 1, 2014, if you submit paper claims, you must use CMS1500 version 2/12 instead of version 8/05.) No one thought there would be another delay—that is, until Thursday, March 27, when the House of Representatives passed HR 4302, a bill that contained a provision to delay the implementation and extend the therapy …

  • The PT's Guide to Billing Image

    downloadJun 7, 2016

    The PT's Guide to Billing

    When it comes to physical therapy billing, you have to know your stuff—because even the simplest mistakes can cause denials. Of course, knowing billing backwards and forwards doesn’t have to be complicated. That’s why we created a comprehensive billing resource specifically for PTs. Take the guesswork out of billing. Enter your email address below, and we’ll send your free guide.

  • This Week in PT News, June 12 Image

    articleJun 12, 2015 | 2 min. read

    This Week in PT News, June 12

    New Study Reveals Why Some Indigenous Cultures Don’t Experience Back Pain According to NPR, California acupuncturist Esther Gokhale recently conducted an investigation into the factors that might explain why some indigenous cultures don’t experience low back pain. Like 75% of Americans, Gokhale has experienced back pain, and she wasn’t convinced Western medicine could cure her ailment. So, she spent ten years visiting and studying populations that report having little to no back pain. She noticed that while …

  • Last Legs: The Compliance Vulnerabilities of Dead or Dying Software Image

    articleOct 24, 2016 | 5 min. read

    Last Legs: The Compliance Vulnerabilities of Dead or Dying Software

    Rusty mechanical equipment. Creaky carnival rides. Wobbly chairs. People are naturally skeptical of things that are dilapidated, rundown, or slipshod—and with good reason. After all, that which is ramshackle usually isn’t reliable. Now, imagine it’s the physical therapy software you use everyday to run your rehab therapy practice that’s gone derelict. Take PTOS EMR, for example , because if you didn’t know, this therapy office software is going out of business, and it has ceased all updates …

  • It’s ICD-10 Crunch Time. Here’s How to Triumph. Image

    articleFeb 18, 2015 | 5 min. read

    It’s ICD-10 Crunch Time. Here’s How to Triumph.

    During Lyndon B. Johnson’s presidency, the administration was under a lot of pressure to fix everything from the Vietnam War to inflation. Naturally, the LBJ team started using the word “crunch” as a noun describing a stressful, crisis-type situation. Handling a crunch required longer hours and laser-focus—hence, “crunch time”—which is precisely what the healthcare industry is in now. Sure, it’s no Vietnam, but with only nine months until the switch—i.e., the day everyone must use ICD-10 codes …

  • Founder Letter: ICD-What? Image

    articleSep 3, 2015 | 7 min. read

    Founder Letter: ICD-What?

    By now, it’s obvious that the entire US healthcare system is going to face a huge change come October 1: the transition to ICD-10 . This new—well, new to us—way of coding has been on the discussion table for decades , and for the last several years, its implementation has been the topic of much anticipation as well as a fair amount of resistance. So, if you find yourself in the dark—completely unaware that ICD-10 is happening—then …

  • The PT’s 2015 ICD-10 Checklist  Image

    webinarFeb 24, 2015

    The PT’s 2015 ICD-10 Checklist

    The ICD-10 switch is upon us—October 1, 2015, to be exact—and you only have about seven months to finalize all of your clinic’s preparations. Feel your brow beading with stress sweat? Instead of fretting, tune in to this must-watch webinar. Hosts Heidi Jannenga and Mike Manheimer will outline everything you and your practice need to do to be ICD-10-ready before the clock runs out. In this session, you’ll learn how to: Assess current clinic diagnosis coding processes …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.