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Claims and Coding ICD-10 FAQ Shelly Guffey

Experts answer the most-asked questions about transitioning to the code set. By Shelly Guffey and Dawn Duchek


he Department of Health and Human Services (HHS) recently announced a proposed rule to delay the ICD-10 compliance deadline from Oct. 1, 2013 to Oct. 1, 2014. However, they have not

yet defi ned which entities will be covered by the change. And, based on what the industry has learned from the transition to 5010, we all know it’s never too early to start preparing! Recently, we presented a webinar with the American

Academy of Professional Coders (AAPC) to inform practices how ICD-10 will impact the way they do business. When we received nearly 400 questions from attendees at that webinar, we realized there is still a lot of confusion about what ICD- 10 is, why we have to make the switch and what changes practices will have to adopt internally to be compliant. Here are answers to the 10 most-common questions we’ve received:

1. What is ICD-10? International Classification of Diseases (ICD) codes are alphanumeric designations that providers assign to every medical diagnosis and description of symptoms for patients. ICD-10 is the 10th updated edi- tion of these codes, which will replace the United States’ current ICD-9 system. 2. Why are we changing to ICD-10? There are multiple reasons for the change to ICD-10. The U.S. is the only country that currently is still using ICD-9, and the switch to ICD-10 will allow us to compare our healthcare data more accurately with other countries. ICD-10’s more expansive system will also help us better track data to measure the qual- ity and safety of care, process claims for reimbursement and improve clinical, fi nancial and administrative performance. 3. When will we begin using ICD-10? Code set usage will depend on whether you are submitting an inpatient or outpatient claim. If you are billing outpatient claims you will use ICD-9 for dates of service prior to Oct. 1, 2013 and ICD- 10 for services on Oct. 1, 2013 and forward. For inpatient claims, the code set will be based on the discharge date. 4. Has ICD-10 been delayed? HHS has announced a proposed rule to delay the ICD-10 implementation date until Oct. 1, 2014. However, the compliance date as of today remains Oct. 1, 2013. 5. Is the switch to ICD-10 just for Medicare and Medic-

aid, or are other insurance companies changing too? HIPAA mandates that all insurance plans in the United States make

8 July 2012

the transition to ICD-10 as of Oct. 1, 2013.

6. How many codes will

there be in ICD-10? ICD-10 will include 140,000 codes, while ICD-9 is made up of only 17,000 codes. The addi-

Shelly Guffey is manager of premier accounts and vendor partners, Gateway EDI; Dawn Duchek is industry initiatives coordinator, Gateway EDI. For more on Gateway EDI:

tion of more codes will allow practices to more-specifi cally report the care they provide to patients on their claims. 7. Where can I fi nd the new ICD-10 code sets? The

ICD-10-CM and ICD-10-PCS code sets are available now free of charge and can be found on the CMS website (www.

8. If we have the ICD-10 codes, can we start using them

now? ICD-10 code sets cannot be used until Oct. 1, 2013. You will need to continue using ICD-9 until that date. 9. Why should I start preparing now for the ICD-10 transition when it doesn’t happen until October 2013? The transition to ICD-10 is a major undertaking for providers, payers and vendors. It will drive business and systems changes throughout the healthcare industry, from large national health plans to small provider offi ces, laboratories, medical testing centers, hospitals and more. To ensure a smooth transition, these organizations need to devote staff time and fi nancial resources to transition activities. So, it’s best to develop a transition plan now and start preparing your staff. A successful transition to ICD-10 will be vital to transforming our nation’s healthcare system and ensuring uninterrupted operations. 10. What type of training will providers and staff need for the ICD-10 transition? Training needs will vary for dif- ferent organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding. You and your staff should take advantage of specialty-specifi c ICD-10 training offered by so- cieties and other professional organizations. CMS and coding associations, such as AAPC, have resources to help providers prepare for a smooth transition to ICD-10. These organiza- tions will continue to add new tools and information to their sites through the course of the transition, so visit regularly to access the latest information and training opportunities. For a compilation of key industry resources on ICD-10, visit


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