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.

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