ICD-10 FAQ

ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9. The system was developed by WHO in the 1970s and is now used in almost every country in the world, except the United States.

In the United States ICD-10 usually refers to the U.S. clinical modification of ICD-10: ICD-10-CM. The code set is scheduled to replace ICD-9-CM, our current U.S. diagnostic code set, on Oct 1, 2015.

Another designation, ICD-10-PCS, for "procedural coding system," will also be adopted in the United States on Oct 1. ICD-10-PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system. The final rule stated CPT® would remain the coding system for physician services.

Learn more about ICD-10 vs. ICD-10-CM vs. ICD-10-PCS

Free ICD-10 White Paper: The History, the Impact, and the Keys to Success

ICD-9-CM has several problems. Foremost, there is no room for expansion of the code set. 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 continues 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 advancing medical care. These same details will streamline claims submissions, since these details will make the initial claim much easier for payers to understand.

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. Healthcare professionals  qualified to code ICD-9-CM should transition to coding ICD-10-CM with minimal effort.

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 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:

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.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/index.html

The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014, that ICD-10-CM and ICD-10-PCS will be implemented into the HIPAA mandated code set on Oct 1, 2015. Additionally, effective Jan 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.

• CMS Transactions and Code Sets Regulations
• CMS Code Sets

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

• Oct 1, 2015 – Compliance date for implementation of ICD-10-CM (diag noses) and ICD-10-PCS (procedures)
  • 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 Oct 1, 2015 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 Oct 1, 2015.

Track Your Progress

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 created a plan to provide accurate and timely assistance to help you to effectively implement ICD-10 on time. The plan is broken down by year (2012 – 2015), 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 personal progress with red, yellow and green lights indicating whether the member is on schedule or not.

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.

Healthcare professionals responsible for a practice’s coding faculty, health information management, or other ICD-10 implementation, must prepare well in advance of code set training. Our ICD-10 training plan suggests implementation training is the first of five steps in ICD-10 preparation.

The steps include:

• ICD-10-CM Implementation Training
• ICD-10-CM Anatomy and Pathophysiology
• ICD-10-CM Code Set Training (Phase one)
• ICD-10-CM Specialty Code Set Training (Phase two)
• ICD-10-CM Proficiency Assessment

Practices, facilities, and hospitals should begin preparing for ICD-10 implementation now. AAPC’s ICD-10 Implementation Training teaches all you will need to know to implement ICD-10 in a practice. This training is available as an ICD-10 Implementation Boot Camp or ICD-10 Implementation On-site Training.

To ensure the ICD-10 coding education is retained through the Oct 1, 2015 implementation date, we recommend waiting until at least late 2012 to begin comprehensive ICD-10 coding training.

We offer essentials training for ICD-10 that can assist practice managers, ancillary staff, and physicians. The training is broken into three sections. In addition to our essentials training, we also offer ICD-10 documentation training to physicians.

CEUs will be offered for each of the training steps and will be equal to the total time of the training. For more details on the CEUs for each training step, please refer to our training roadmap.

The steps 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 Training.

Due to the clinical nature of ICD-10-CM it is recommended that those without a 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.

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 wanting 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).

The ICD-10 Proficiency Assessment is the only step of this roadmap required for all certified AAPC members (excluding CIRCC, CPB, CPPM, and CPCO). 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 until Dec 31, 2015 to pass an open-book, online, unproctored assessment.

The assessment will measure your understanding of ICD-10-CM format and structure, groupings and categories of codes, ICD-10-CM official guidelines, and coding concepts. You have two options to complete the assessment: