As of October 1, 2015, healthcare providers and payers alike will convert to ICD-10’s, which consist of more than 69,000 new codes. The intent is to streamline clinical communication by implementing new and more detailed 7-digit alphanumeric codes. Avella has provided this FAQ and resource guide for your office.  

ICD-10 compliance means that all HIPAA-covered entities are able to successfully conduct health care transactions on or after October 1, 2015, using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after this date.

ICD-10 is a provision of HIPAA, as regulated by the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS). This federal mandate pertains to all HIPAA-covered entities.

The transition from ICD-9 to ICD-10 is occurring for the following reasons:

  • ICD-9 codes have limited data about the patient’s medical conditions and hospital inpatient procedures.
  • ICD-9 codes use outdated and obsolete terms and are not consistent with current medical practices.
The structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. A successful transition to ICD-10 is vital to transforming our nation’s health care system.

ICD-10 codes are different from ICD-9 codes in two key ways:

  • Currently, ICD-9 codes are for the most part numeric and have three to five digits. ICD-10 codes are alphanumeric and contain three to seven characters. 
  • ICD-10 codes provide a higher level of description.

However, like ICD-9 codes, ICD-10 codes will be updated every year.

No. The transition to ICD-10 does not affect CPT coding for outpatient procedures. For hospital inpatient procedures, ICD-9 codes will be transitioned to ICD-10-PCS (Procedure Coding System).

As of October 1, 2015, medical coding in U.S. health care settings will change from ICD-9 code sets to ICD-10 code sets.

Everyone covered by HIPAA must transition to ICD-10. This includes providers and payers who do not deal with Medicare or Medicaid claims.

For HIPAA-covered entities, transition to ICD-10 is not an option. Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedure codes. This change does not apply to Current Procedural Terminology (CPT) coding for outpatient procedures. Without ICD-10, providers will experience delayed payments or even non-payments; increased rejected, denied or pending claims; reduced cash flows and ultimately lost revenues.

It is important to note, however, that claims for services and inpatient procedures provided before October 1, 2015, must use ICD-9 codes.

This is unlikely. All payors should be ready for the transition, and many may accept ICD-9 or ICD-10 codes.

Yes. All claim transactions, whether paper or electronic, except dental claims, will be required to be submitted using ICD-10 codes. 

Yes. Any TAR currently requiring an ICD-9 diagnosis code will require an ICD-10 diagnosis code on or after October 1, 2015.