Below is a list of frequently asked questions about ICD-10, ICD-10 implementation, and how to get
trained and prepared.
What is ICD-10?
ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace
ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except
the United States.
When we hear “ICD-10” in the United States, it usually refers to the U.S. clinical modification
of ICD-10: ICD-10-CM. This code set is scheduled to replace ICD-9-CM, our current U.S. diagnostic
code set, on Oct. 1, 2014.
Another designation, ICD-10-PCS, for “procedural coding system,” is will also be adopted
in the United States. ICD-10-PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding
system. The final rule stated that CPT® would remain the coding system for physician services.
Learn more about ICD-10 vs. ICD-10-CM vs.
Free ICD-10 White Paper: The History, the Impact, and the Keys
Why is the United States moving
ICD-9-CM has several problems. Foremost, it is out of room. Because the classification is organized
scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories
have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers
to assign these diagnoses.
Computer science, combined with new, more detailed codes of ICD-10-CM, will allow for better analysis
of disease patterns and treatment outcomes that can advance medical care. These same details will
streamline claims submissions, since these details will make the initial claim much easier for payers
How is ICD-10-CM different from our current system?
In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are
very similar. The organization of the codes is very similar. Anyone who is qualified to code ICD-9-CM
should be able to make the transition to coding ICD-10-CM.
Many improvements have been made to coding in ICD-10-CM. For example, a single code can report a
disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture
care, the code differentiates an encounter for an initial fracture; follow-up of fracture healing
normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture.
Likewise, the trimester is designated in obstetrical codes.
While much has been said about the huge increase in the number of codes under ICD-10-CM, some of
this growth is due to laterality. While an ICD-9-CM code may identify a condition of, for example,
the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left
ovary, or bilateral condition of the ovaries.
The big differences between the two systems are differences that will affect information technology
and software at your practice. Here’s a chart showing the differences:
Volume of codes
Composition of codes
Mostly numeric, with E and V codes alphanumeric. Valid codes
of three, four, or five digits.
All codes are alphanumeric, beginning with a letter and with
a mix of numbers and letters thereafter. Valid codes may have three, four, five, six
or seven digits.
Duplication of code sets
Currently, only ICD-9-CM codes are required. No mapping is necessary.
For a period of two years or more, systems will need to access
both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM.
Mapping will be necessary so that equivalent codes can be found for issues of disease
tracking, medical necessity edits and outcomes studies.
What about ICD-10-PCS?
ICD-10-PCS is a code set designed to replace Volume 3 of ICD-9-CM for inpatient procedure reporting.
It will be used by hospitals and by payers. ICD-10-PCS is significantly different from Volume
3 and from CPT® codes and will require significant training for users. The system was designed
by 3M Health Information Management for the Centers for Medicare and Medicaid.
ICD-10-PCS will not affect coding of physician services in their offices. However, physicians should
be aware that documentation requirements under ICD-CM-PCS are quite different, so their inpatient
medical record documentation will be affected by this change.
ICD-10-PCS has nearly 79,000 seven-digit alpha-numeric codes. Codes are selected from complex grids,
based on the type of procedure performed, approach, body part, and other characteristics. The code
system does not use medical terminology based on Latin or eponyms. More information on ICD-10-PCS,
including an informative PowerPoint presentation that describes the coding system, can be found at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp
What is HIPAA 5010 and when will it be implemented?
The Health Insurance Portability and Accountability Act (HIPAA) 5010 was adopted to replace the current
version of the X12 standard that covered what entities (health plans, health care clearinghouses,
and certain health care providers) must use when conducting electronic transactions. Version
4010 is currently being used under HIPAA standards, however there are two very important HIPAA
5010 dates to remember:
- January 1, 2011 Level I compliance—ability to process 5010 transactions for testing and
transition with able trading partners
- January 1, 2012 Level II compliance—all covered entities must begin using 5010 transactions
The new submission standard will accommodate the increased size and complexity in ICD-10 codes and
relate almost entirely too health care transactions in the same way that 4010 is currently used.
The implementation of the 5010 standard will require changes to the software, systems, and procedures
currently used to bill Medicare and other payers. Part of preparing for ICD-10 implementation
should naturally include the 5010/D.0/3.0 progressions as milestones in the overall implementation
process. Those affected by the upgrades include all HIPAA covered entities; this means providers,
health plans and clearinghouses. Additionally, business associates of these covered entities
that use covered transactions for example, billing or service firms.
Learn more about HIPAA 5010 implementation.
When will ICD-10-CM and ICD-10-PCS be implemented?
The Centers for Medicare and Medicaid Services (CMS) announced in January of 2009 that ICD-10-CM
and ICD-10-PCS will be implemented into the HIPAA mandated code set on October 1, 2014.
Additionally, effective January 1, 2012, you must be ready to submit your claims
electronically using the X12 Version 5010 and NCPDP Version D.0 standards. This also is a prerequisite
for implementing the new ICD-10 codes.
What is the grace period for the use of ICD-9 codes submitted after implementation of the
new ICD-10 codes?
CMS has indicated in their FAQ's that there will be no delay in implementation of ICD-10. The following
are excerpts from CMS’ website:
Remember: ICD-10 Compliance Date for Implementation
- October 1, 2014 – Compliance date for implementation of ICD-10-CM (diagnoses) and
- No delays
- No grace period
- CMS Myth and Fact Sheet
Implementation planning should be undertaken with the assumption that the Department of Health
and Human Services (HHS) will grant an extension beyond the October 1, 2014 compliance date.
HHS has no plans to extend the compliance date for implementation of ICD-10-CM/PCS; therefore, covered
entities should plan to complete the steps required in order to implement ICD-10-CM/PCS on October
What can I do to prepare for ICD-10-CM?
While there will need to be significant education and training for coders, billers, practice managers,
physicians, and other health care personnel to fully implement this major code change, no one needs
to panic. AAPC has a plan in place to provide
accurate and timely assistance to permit you to effectively implement ICD-10 on time. The plan
is broken down by year (2012 – 2014), incorporates both implementation
training and code set training, and
is delivered either live or online.
As part of the implementation plan, AAPC has provided its members and those enrolled in our training
with an “Implementation Tracker.” This
online application tracks and graphically measures the ICD-10 implementation progress of an individual
or organization, giving members the ability to easily enter in personal progress with red, yellow
and green lights that indicate whether the member is on schedule or not.
Training vs. Code Set Training
Anyone responsible for a practice’s coding faculty, health information management, and other
ICD-10 implementation, must prepare well in advance of code set training. The ICD-10
training plan suggests implementation training is the first of five steps in ICD-10 preparation.
The steps include:
What do you offer for implementation training and when should our office begin?
Practices, facilities and hospitals should begin preparing for ICD-10 implementation now. AAPC’s ICD-10
Implementation Training teaches all that you will need to know to implement ICD-10 in a practice.
This training is currently available as an ICD-10
Implementation Boot Camp or ICD-10
Implementation On-site Training.
When should I begin comprehensive code-set training?
To ensure the ICD-10 coding education is retained through the October 1, 2014 implementation date,
we recommend waiting until at least late 2012 to begin comprehensive ICD-10
Will CEU's be given for ICD-10 training?
CEUs will be offered for each of the training steps and will be equal to the total time of the training.
For more detail on the CEUs for each training step, please refer to our training
Do coders need every training step in the Coder’s Roadmap to ICD-10?
listed on AAPC’s Coder’s
Roadmap to ICD-10 are strongly recommended for coder’s preparing for ICD-10. However,
some training steps may be skipped with prior experience or knowledge. For example, coders who
do not wish to learn the implementation process of ICD-10 may want to skip Step 1: ICD-10 Implementation
Why should a coder take ICD-10 Anatomy and Pathophysiology training?
Due to the clinical nature of ICD-10-CM it is recommended that those without a very strong understanding
of, or experience in anatomy and/or physiology strongly consider a refresher course. AAPC’s ICD-10
Anatomy and Pathophysiology training covers all body systems in 14 modules and helps
coders prepare for the advanced specificity and stronger clinical knowledge requirements of ICD-10.
Do I need Specialty ICD-10 Code Set training? I don’t work in a specialty.
Specialty ICD-10 Code Set training is divided into a single multi-specialty training course
or twenty (20) specialty-specific trainings. It is recommended for those that want more detailed
training for a particular specialty or more advanced multi-specialty training. Specialty code set
training is not required to pass the ICD-10 Proficiency Assessment (Step 5).
What is the ICD-10 Proficiency Assessment and is it required?
The ICD-10 Proficiency Assessment is the only step of this roadmap required for all certified
AAPC members (excluding CIRCC, CPPM, and CPCO). You should prepare yourself as you would for other exams or assessments. To ensure
employers continue to have confidence in a certified coder’s ability to accurately code the
current code sets, AAPC certified members will have two years to pass an open-book, online, unproctored
It will measure your understanding of ICD-10-CM format and structure, groupings and categories of
codes, ICD-10-CM official guidelines, and coding concepts.
- Required for AAPC certified coders (excluding CIRCC, CPPM, and CPCO), recommended for all other coders
- Two (2) years to take and pass the assessment, beginning October 1, 2013 (one year before implementation
of ICD-10) and ending September 30, 2015 (one year after implementation)
- 75 questions, 3.5 hours, open-book, online, and unproctored
- Coders will have two (2) attempts at passing for the $60 administration fee
- ICD-10-CM only (ICD-10-PCS will not be covered in the assessment)
- No CEUs given