ICD-10 FAQ

AAPC continues to actively guide healthcare professionals through the October 1, 2015, ICD-10 implementation as mandated by the Centers for Medicare and Medicaid Services (CMS). We maintain our commitment to serving more than 140,000 AAPC members and the broader healthcare community to ensure all are prepared for the changes in healthcare – whenever they occur. We will continue to provide policy leaders and influencers with the most extensive information available to ensure prudent decisions are made and progress-impeding uncertainty can be eliminated.

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?
• Why is the United States moving to ICD-10-CM?
• What is AAPC doing to prepare AAPC Members and the industry for ICD-10 implementation?
• How is ICD-10-CM different from our current system?
• What about ICD-10-PCS?
• When will ICD-10-CM and ICD-10-PCS be implemented?
• What is the grace period for the use of ICD-9 codes submitted after implementation of the new ICD-10 codes?
• What can I do to prepare for ICD-10-CM?
• Implementation Training vs. Code Set Training
• What do you offer for implementation training and when should our office begin?
• When should I begin comprehensive code-set training?
• What do you offer for physicians or practice managers that need to understand ICD-10 and how it will affect our practice?
• Will CEU's be given for ICD-10 training?
• Do coders need every training step in the Coder’s Roadmap to ICD-10?
• Why should a coder take ICD-10 Anatomy and Pathophysiology training?
• Do I need Specialty ICD-10 Code Set training? I don’t work in a specialty.
• What is the ICD-10 Proficiency Assessment and is it required?

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, 2015.

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. ICD-10-PCS

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

Why is the United States moving to ICD-10-CM?

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 to understand.

What is AAPC doing to prepare AAPC Members and the industry for ICD-10 implementation?

AAPC continues to actively guide healthcare professionals through the October 1, 2015, ICD-10 implementation as mandated by the Centers for Medicare and Medicaid Services (CMS). We maintain our commitment to serving more than 140,000 AAPC members and the broader healthcare community to ensure all are prepared for the changes in healthcare – whenever they occur. We will continue to provide policy leaders and influencers with the most extensive information available to ensure prudent decisions are made and progress-impeding uncertainty can be eliminated. (See ICD-10 Delay FAQs for more details)

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:

Issue	ICD-9-CM	ICD-10-CM
Volume of codes	approximately 13,600	approximately 69,000
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

When will ICD-10-CM and ICD-10-PCS be implemented?

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 October 1, 2015. 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.

• CMS Transactions and Code Sets Regulations
• CMS Code Sets

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, 2015 – Compliance date for implementation of ICD-10-CM (diagnoses) 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 October 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 October 1, 2015.

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 – 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 in personal progress with red, yellow and green lights that indicate whether the member is on schedule or not.

Implementation 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:

• 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

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, 2015 implementation date, we recommend waiting until at least late 2012 to begin comprehensive ICD-10 coding training.

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 roadmap.

Do coders need every training step in the Coder’s Roadmap to ICD-10?

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.

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, CPB, 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 until December 31, 2015 to pass an open-book, online, unproctored assessment.

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. You have two options to complete the assessment: