ICD-10 questions and answers

So, you’ve got some questions about ICD-10. We don’t blame you. There’s a lot going on with the transition to these new diagnostic codes―which will occur October 1, 2015―and it’s best to be on your toes. That’s why we put together this handy-dandy list of questions―and, more importantly, answers―to help you stay on pointe.

What’s ICD-10?

ICD-10 is the tenth revision to the International Classification of Diseases. Check out this World Health Organization article for a complete history on how the International Classification of Diseases came to be (hint: the classification began in the 17th and 18th centuries as Causes for Death).

Why is ICD-10 replacing ICD-9?

Well, in addition to being 30+ years old (read: outdated and inconsistent with modern medical practice around the world), CMS says that the current diagnostic coding system (ICD-9) doesn’t produce specific enough data about patients’ medical conditions and inpatient procedures. Furthermore, ICD-9’s structure limits the introduction of new codes and caps the code categories, preventing the seamless addition of new classifications.

ICD-10, however, provides practitioners with the ability to describe a patient’s diagnosis and classify inpatient procedures with significantly more “specificity and exactness.” This new system will also “accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing” as well as make it easier for CMS to detect fraud.

Is there a difference between ICD-10-CM and ICD-10-PCS?

Yes, there is a difference. ICD-10-CM is the diagnosis classification system for use in all US health care treatment settings. Although the format is similar to ICD-9-CM, ICD-10-CM uses three to seven alpha and numeric digits as well as full code titles. ICD-10-PCS is the procedure classification system for use in US inpatient hospital settings only.

If these are international codes, why are we the only ones making the switch?

We’re not. In fact, we’re the last country with modern health care to make the transition to ICD-10. Australia transitioned in 1998, and Canada transitioned in 2001.

Which providers have to comply?

All practitioners subject to the Health Insurance Portability Accountability Act (HIPAA)—whether or not they submit Medicare or Medicaid claims—must use ICD-10 diagnosis codes starting October 1, 2015.

Will ICD-10 codes replace CPT codes?

According to this APTA article, CPT codes will change for hospital inpatient billing, but outpatient providers and other clinicians will continue to use the existing CPT codes. 

Should I use ICD-10 codes for auto and worker’s compensation claims, too?

It is our understanding that you’ll continue to use ICD-9 codes when submitting auto and worker’s compensation claims.

Will my EMR and billing software be ready to handle the new codes?

Absolutely―if you’re using WebPT. We’ll be ready to handle ICD-10 codes before October 1, 2015. If you’re not a WebPT member, be sure to ask your EMR vendor immediately―or give us a call at 1.866.221.1870.

October 2014 feels so far away. Do I really have to start thinking about this now?

Of course you don’t have to―but you should―for your practice’s sake as well as your sanity’s. Here are five things you can do starting today to make the transition easier:

  1. Stop resisting the inevitable and face the facts
  2. Elect an ICD-10 leader or champion for your practice
  3. Create a plan
  4. Start training
  5. Begin testing

Should I start saving money now, just in case?

Yes, experts recommend having at least six months’ worth of extra revenue available. This will help you compensate for challenges (like dips in productivity or delays in reimbursements) that may arise following ICD-10 implementation. It might also be worth thinking about having a Plan B, like a line of credit, as WebPT Co-Founder and COO, Heidi Jannenga recommends.

Where can I learn more?

Follow CMS on Twitter and visit www.cms.gov/ICD10 to sign up for the CMS ICD-10 email updates to receive the latest news and resources on ICD-10. Also, check out the WebPT blog frequently for more implementation news.

Here are a few more great resources to consider:

  • 62 regional extension centers (RECs) are helping small practices transition to EMR/EHR.
  • The APTA is publishing new ICD-10 information regularly.
  • CMS has many ICD-10 resources available, including general information, latest news, checklists, and an implementation timeline.