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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Frequently Asked Questions

Q. What is ICD?

A: The International Classification of Diseases (ICD) is a common framework and language to report, compile, use and compare health information.

In 1893, the first edition was adopted, known as the International Cause of Death.

In 1948, the World Health Organization (WHO) took responsibility for ICD with the sixth revision. WHO updates the ICD periodically to reflect current epidemiology and medical understanding of disease (i.e., ICD-7 through 10).

Q. Why are we changing from ICD-9?

A: ICD-9-CM no longer supports advances in medicine and new procedures; therefore, it is obsolete. It does not have the capacity to expand and incorporate new codes. The United States is the last developed country to implement ICD-10-CM which restricted our ability to track and respond to disease patterns (e.g. H1N1) and epidemics on a worldwide basis. In addition, the detail in the code is expected to streamline claims for payers to clearly understand the purpose of the patient visit.

Q. What is ICD-10-CM/PCS?

A: In the United States, ICD is modified to report disease morbidity, as well as, mortality data and inpatient procedures. The United States modified versions are called Clinical Modification (CM) and Procedural Classification System (PCS).

Q. What is the implementation date for ICD-10?

A: The new compliance date for implementation of the ICD-10-CM/PCS Code Sets is October 1, 2014 for all Health Insurance Portability and Accountability Act (HIPAA) covered entities.

Q. Why do we need ICD-10-CM?

A: Structurally, ICD-9-CM is running out of room to add new codes. New diagnosis codes are submitted by medical societies, quality monitoring organizations and others annually.

ICD-10-CM will allow for more codes and greater specificity; therefore, result in better epidemiological tracking; promote better analysis of disease patterns and treatment outcomes; support quality measurement efforts; lead to accurate reimbursement; and support waste, fraud and abuse initiatives.

Q. How are ICD-9-CM and ICD-10-CM different?

A: The ICD-10-CM codes are very different from those currently used in ICD-9-CM. All codes in ICD-10-CM are alpha-numeric and may be up to seven alpha-numeric characters. This requires billing software program changes to accommodate the additional digits, as well as, extensive coder training. ICD-10-CM codes will be able to provide more specific and in-depth information about the patient's condition.

Examples:

    Precordial Chest Pain
      ICD-9-CM: 786.51

      ICD-10-CM: R07.2

    Asthma, Acute Exacerbation
      ICD-9-CM: 493.92

      ICD-10-CM:
      J45.21 Mild, intermittent, w/acute exacerbation
      J45.41 Moderate, persistent, w/acute exacerbation left
      J45.51 Severe, persistent, w/acute exacerbation

    Thumb, w/o nail damage, initial encounter
      ICD-9-CM: 883.0

      ICD-10-CM:
      S61.011A Laceration without foreign body of right thumb without damage to nail, initial encounter
      S61.012A Laceration without foreign body of left thumb without damage to nail, initial encounter
Just as with ICD-9-CM, clear physician documentation will be important to properly code assignment.

Q. What is GEM?

A: General Equivalence Mappings (GEM) were developed by the Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control (CDC), with collaboration of the American Health Information Management Association (AHIMA) and the American Hospital Association (AHA), as a tool to assist with the conversion from ICD-9-CM codes to ICD-10-CM and the conversion of ICD-10-CM codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10-CM coding systems. GEMs are also referred to as crosswalks since they provide important information linking codes from one system with codes to the other system.

In some instances, there is no translation between an ICD-9-CM code and an ICD-10-CM code. When there is no plausible translation from a code in one system to a code in the other system, a "No Map" flag indicator is noted.

Q. What is ICD-10-PCS?

A: ICD-10-PCS (Procedure Classification System) is designated to replace Volume 3 of ICD-9-CM for hospital inpatient use. The cooperating parties and especially Centers for Medicare & Medicaid Services (CMS) have made it very clear that there is no intention for ICD-10-PCS to replace CPT for the identification of physician work. Its intention is to identify inpatient facility services in a way not directly related to physician work, but directed towards allocation of hospital services.

CPT remains the procedure coding standard for physicians, regardless of whether the physician services were provided in the inpatient or outpatient setting. Any third party payer asking for Volume 3 procedure codes to be submitted along with CPT codes for outpatient services is in violation of HIPAA regulations.

Q. Where can I learn more about ICD-10-CM and ICD-10-PCS?

A: For an in-depth discussion of the features and challenges of ICD-10-CM and ICD-10-PCS, visit the CMS website for ICD-10.

Q. Will coders need to be re-trained to use ICD-10-CM?

A: Yes. The Health Information Management and Coding industry recommends that an assessment of the coding staff be done in order to determine their proficiency in bioscience. ICD-10-CM is clinical in nature and staff with less experience in anatomy and physiology and other bioscience topics should consider refresher courses. ICD-10-CM recommends intensive training six to nine months before the compliance date. Detailed training in a given specialty is also recommended.

AAPC Coder's Roadmap to ICD-10 [PDF].

AHIMA ICD-10 Continuing Education Requirements for Certified Professionals [PDF - 1 MB]

Q. What will be the ICD-10-CM requirements for certified coders?

A: Coders already credentialed as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) should review the requirement from the credentialing organization. Also, the ICD-10-CM transition presents a good opportunity for people looking for a career change or advancement by obtaining ICD-10-CM training and coding certification.

AAPC Coder's Roadmap to ICD-10 [PDF].

AHIMA ICD-10 Continuing Education Requirements for Certified Professionals [PDF - 1 MB]

Q. Why should I prepare now?

A: The time is now to prepare for migration from ICD-9-CM to ICD-10-CM, as it will be challenging. Information, education and advance planning are critical to success. The process of implementing ICD-10-CM is not only complex, but it will affect every aspect of the medical practice and reimbursement. If you start your planning process now, issues can be identified and resolved early on, making the conversion less stressful and more successful.

Q. What is Version 5010, and how is it related to ICD-10-CM?

A: Along with the ICD-10-CM implementation, CMS mandated a transition, effective Jan. 1, 2012, to version 5010 of electronic transaction standards under HIPAA. This transition is necessary because version 4010 of the standards originally named in HIPAA, which was passed in 1996, are outdated and cannot accommodate ICD-10-CM. For more information see the CMS website on Version 5010 .

Q. What are the different applications available for mapping ICD-10-CM codes?

A: CMS embarked on a project to convert Medicare severity diagnosis-related groups (MS-DRG) to ICD-10-CM codes and also offers tools called General Equivalence Mappings (GEMs) for clinical modification and procedure classification systems. For more information on mapping, see the CMS website on 2014 ICD-10-CM and GEMs .

Q. Who needs education on ICD-10-CM & ICD-10-PCS?

A: All the people associated with patient care and users of ICD data will need to undergo some level of education in ICD-10-CM. As an example, administration would need an awareness of the impact the transition will have on workflow productivity for coding and billing and its potential impact with revenue shifts. Enough education is needed to understand the ICD-10-CM code changes to address allocation of resources for training, for backlogs, and for planning any related staffing concerns during and post implementation (i.e., overtime, hiring of more staff, or contracting for coding/billing services, etc.). Administrators should also have the ICD-10-CM knowledge base to understand the need to closely monitor denied/rejected claims, plan to provide additional ICD-10-CM education and address documentation, as appropriate.

Another example would be to provide physicians with education on the need to document to the level of ICD-10-CM specificity. ICD-10-CM allows for very specific code assignment when provider documentation includes anatomical location (including laterality), trimester, episode of care, and acuity of condition. In order to lessen the impact and take advantage of the robust ICD-10-CM code set, ICD-10-CM education and clinical documentation improvement efforts need to be in place well before the compliance date.

The following disciplines will need some ICD-10-CM training:

  • Medical Coding and Billing Professionals
  • Providers to include, but not limited to: Physicians, Nursing, Lab, Radiology, Physical Therapy, Optometry, etc.
  • Health Information Management staff
  • Information Technology and Information Systems Personnel
  • Data Analysts
  • Administrators
  • Case Managers
  • Quality Management Staff
  • Patient Access and Registration Staff
  • Injury Control
  • Accounting Professionals
  • Auditors and Consultants
  • Clinical Department Managers
  • Allied Health care professionals

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