|International Classification of Diseases (ICD-10)|
Frequently Asked Questions (FAQs)
FAQ 1. What is ICD?The International Classification of Diseases (ICD) is a common framework and language to report, compile, use and compare health information:
FAQ 2. Why are we changing from ICD-9?The current revision of ICD used in the United States is obsolete. ICD-9 no longer supports advances in medicine and new procedures. It does not have the capacity to expand and incorporate new codes. The United States is the last developed country to implement ICD-10 which restricted our ability to track and respond to disease patterns (e.g. H1N1) and epidemics on a worldwide basis. Also, the detail in the codes is expected to streamline claims for payers to clearly understand the purpose of the patient visit.
FAQ 3. What is ICD-10-CM/PCS?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).
FAQ 4. What is the implementation date for ICD-10?The new compliance date for implementation of the ICD-10-CM/PCS Code Sets is October 1, 2014 for all HIPAA covered entities.
FAQ 5. Why do we need ICD-10-CM?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 not only for more codes but also for greater specificity and thus better epidemiological tracking, analysis of disease patterns and treatment outcomes, supports quality measurement efforts, and leads to accurate reimbursement and supports waste, fraud and abuse initiatives.
FAQ 6. How are ICD-9-CM and ICD-10-CM different?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. There may be up to seven alpha-numeric characters, requiring 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.
Just as with ICD-9-CM, clear physician documentation will be important to proper code assignment.
FAQ 7. What is GEM?General Equivalence Mappings (GEM) were developed by CMS and CDC, with collaboration of the AHIMA and the 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 and are also referred to as crosswalks since they provide important information linking codes of one system with codes in the other system.
In some instances, there is not a 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.
FAQ 8. What is ICD-10-PCS?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 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.
FAQ 9. Where can I learn more about ICD-10-CM and ICD-10-PCS?For an in-depth discussion of the features and challenges of ICD-10-CM and ICD-10-PCS, visit this link: http://www.cms.gov/ICD10
FAQ 10: Will coders need to be re-trained to use ICD-10?Yes. The Health Information Management and Coding industry recommend that an assessment of coding staff be done, in order to determine their proficiency in bioscience courses that would prepare coders for ICD-10. ICD-10 is clinical in nature and those staff with less experience in anatomy and physiology and other bioscience topics should consider refresher courses. ICD-10 intensive training six to nine months before the compliance date is recommended. Consideration for more detailed training in a given specialty is also recommended. See the links in FAQ #11 for further information on training recommendations.
FAQ 11: What will be the ICD-10 requirements for certified coders?Coders already credentialed as CPC or CCS should review the requirement from the credentialing organization. Also, the ICD-10 transition presents a good opportunity for people looking for a career change or advancement by obtaining ICD-10 training and coding certification.
FAQ 12: Why should I prepare now?The time is now to prepare for migration from ICD-9 to ICD-10, as it will not be without challenges, that is the reason information, education and advance planning are critical to success. The process of implementing ICD-10 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.
FAQ 13: What is Version 5010, and how is it related to ICD-10?Along with the ICD-10 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. For more information see: CMS Version 5010
FAQ 14: What are the different applications available for mapping ICD-10 codes?CMS embarked on a project to convert Medicare severity diagnosis-related groups (MS-DRG) to ICD-10 codes and also offers tools called General Equivalence Mappings or GEMs for clinical modification and procedure classification systems. For more information on mapping see CMS MD-DRG Conversion Project and CMS GEMS Mapping .
FAQ 15: Who needs education on ICD-10-CM & ICD-10-PCS?All the people associated with patient care and users of ICD data will need to undergo some level of education in ICD-10. 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 to understand the ICD-10 code changes to address allocation of resources for training, for backlogs, and for planning any related staffing concerns during and post the implementation date (i.e., overtime, hiring of more staff, or contracting for coding/billing services, etc.) should be provided. Administrators should also have the ICD-10 knowledge base to understand the need to closely monitor denied/rejected claims and plan to provide additional ICD-10 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 specificity. ICD-10 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 code set, ICD-10 education and clinical documentation improvement efforts need to be in place well before the compliance date.
The following disciplines will need some ICD-10 training: