ICD-10 Information Alert

INFORMATION ALERT:  ICD-10-CM

As of October 1, 2015 the diagnosis codes reported on healthcare claim forms changed from version ICD-9-CM to ICD-10-CM.  It is important to note that HCPC codes and CPT4 codes are not impacted by this transition.

Important Frequently Asked Questions

• Codes change every year, so why is the transition to ICD-10-CM any different from the annual code changes?
  
  ICD-10-CM codes are different from ICD-9-CM codes.  ICD-10-CM has a completely different structure from ICD-9-CM.  Currently, ICD-9-CM codes are mostly numeric and have 3 to 5 digits.  ICD-10 codes will be alphanumeric and contain 3 to 7 characters.  ICD-10-CM is more robust and descriptive with “one too many” matches in most instances.  Like ICD-9-CM codes, ICD-10-CM codes will be updated every year.

• What is the difference between ICD-10-CM and ICD-10-PCS?
  
  ICD-10-CM stands of Clinical Modification and are diagnosis codes only.  ICD-10-PCS stands for Procedural Classification System. These codes are using for hospital inpatient procedural coding only.

• Can a claim be submitted with both ICD-9-CM and ICD-10-CM codes?
  
  Providers may not submit a single claim with both ICD-9-CM and ICD-10-CM codes.  A claim received with codes from both code sets will be rejected at the clearinghouse.  If it is not rejected at the clearinghouse, it will be rejected through our EDI validation processes.

• What claims must comply with the new rules?
  
  Claims submitted after the implementation date that contain dates of service before the implementation date must use ICD-9-CM codes. All claims with dates of service of October 1, 2015 or later must be submitted with a valid ICD-10-CM code.
  
  ICD-9-CM codes will no longer be accepted on either electronic and paper claims with FROM dates of service (on professional and supplier claims) or dates of discharge/THROUGH dates (on institutional claims) on or after October 1, 2015. These claims will be DENIED; there is no grace period or exception to the rule.

• What about services that span the 10/1/2015 date?
  
  Professional claims and outpatient institutional claims must use the ICD-9-CM code for dates of service prior to 10/1/2015 and ICD-10-CM code for dates of service on or after 10/1/2015. These claims will be split.
  
  Inpatient institutional claims must use ICD-10-CM codes for claims with date of discharge 10/1/2015 or later, even when the admit date was prior to 10/1/2015.

• Will the use of CPT codes be affected?
  
  No. ICD-10 procedure codes will only be used for facility reporting of hospital inpatient services. Current Procedural Terminology (CPT®) codes will continue to be used for physician and outpatient services.

• Do physicians need to use all the codes in ICD-10-CM?
  
  Just as no healthcare provider uses every code in ICD-9-CM today, physicians and other providers will not use all the codes in ICD-10-CM. They will use a subset of codes based on their practice and patient population. The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used. Also, laterality accounts for nearly half of the increase in the number of codes in ICD-10-CM.

• Will the use of unspecified codes be allowed after ICD-10-CM is implemented?
  
  Yes, unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular