Here are 10 frequently asked questions about ICD-10, based on information from the Centers for Medicare and Medicaid Services. More information on ICD-10 from CMS can be accessed on the agency's website.
Q: What is the ICD-10 compliance date?
A: October 1, 2013.
Q: Will the transition to ICD-10 be postponed?
A: No. The October 1, 2013 compliance date is firm. There are no plans to extend the deadline.
Q: What does ICD-10 compliance mean?
A: ICD-10 compliance means that all HIPAA covered entities are able to successfully conduct healthcare transactions on or after October 1, 2013 using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for healthcare services provided on or after this date.
Q: Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding?
A: No. This change does not affect CPT coding for outpatient procedures. ICD-10 procedure codes are for hospital inpatient procedures only.
Q: Who is affected by the transition to ICD-10? If I don't deal with Medicare claims, will I have to transition?
A: Everyone covered by the HIPAA must transition to ICD-10 on October 1, 2013, including providers and payers who do not deal with Medicare claims.
Q: Do state Medicaid programs need to transition to ICD-10?
A: Yes. Like all other HIPAA covered entities, state Medicaid programs must comply with ICD-10 by October 1, 2013. CMS is continuing to work with Medicaid programs to help ensure they meet the deadline.
Q: What happens if I don't switch to ICD-10?
A: Claims for all services and hospital inpatient procedures provided on or after October 1, 2013, must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for service and inpatient procedures provided before October 1, 2013, must use ICD-9 codes even if they are submitted after the compliance date.
Q: If I transition early to ICD-10, will CMS be able to process my claims?
A: No. CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2013, compliance date. However, you should plan to start ICD-10 testing with payers beginning in 2012.
Q: Codes change every year, so why is the transition to ICD-10 any different from the annual code changes?
ICD-10 codes are different from ICD-9 codes. ICD-10 has a completely different structure from ICD-9. Currently, ICD-9 codes are mostly numeric and have 3-5 digits. ICD-10 codes will be alphanumeric and contain 3-7 characters. ICD-10 is more robust and descriptive with "one to many" matches in some instances.
Like ICD-9 codes, ICD-10 codes will be updated every year.
Q: Why is the transition to ICD-10 happening?
A: The transition is occurring because ICD-9 codes have limited data about patients' medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated and obsolete terms and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. A successful transition to ICD-10 will be vital to transforming our nation's healthcare system.
Q: What is the ICD-10 compliance date?
A: October 1, 2013.
Q: Will the transition to ICD-10 be postponed?
A: No. The October 1, 2013 compliance date is firm. There are no plans to extend the deadline.
Q: What does ICD-10 compliance mean?
A: ICD-10 compliance means that all HIPAA covered entities are able to successfully conduct healthcare transactions on or after October 1, 2013 using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for healthcare services provided on or after this date.
Q: Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding?
A: No. This change does not affect CPT coding for outpatient procedures. ICD-10 procedure codes are for hospital inpatient procedures only.
Q: Who is affected by the transition to ICD-10? If I don't deal with Medicare claims, will I have to transition?
A: Everyone covered by the HIPAA must transition to ICD-10 on October 1, 2013, including providers and payers who do not deal with Medicare claims.
Q: Do state Medicaid programs need to transition to ICD-10?
A: Yes. Like all other HIPAA covered entities, state Medicaid programs must comply with ICD-10 by October 1, 2013. CMS is continuing to work with Medicaid programs to help ensure they meet the deadline.
Q: What happens if I don't switch to ICD-10?
A: Claims for all services and hospital inpatient procedures provided on or after October 1, 2013, must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for service and inpatient procedures provided before October 1, 2013, must use ICD-9 codes even if they are submitted after the compliance date.
Q: If I transition early to ICD-10, will CMS be able to process my claims?
A: No. CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2013, compliance date. However, you should plan to start ICD-10 testing with payers beginning in 2012.
Q: Codes change every year, so why is the transition to ICD-10 any different from the annual code changes?
ICD-10 codes are different from ICD-9 codes. ICD-10 has a completely different structure from ICD-9. Currently, ICD-9 codes are mostly numeric and have 3-5 digits. ICD-10 codes will be alphanumeric and contain 3-7 characters. ICD-10 is more robust and descriptive with "one to many" matches in some instances.
Like ICD-9 codes, ICD-10 codes will be updated every year.
Q: Why is the transition to ICD-10 happening?
A: The transition is occurring because ICD-9 codes have limited data about patients' medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated and obsolete terms and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. A successful transition to ICD-10 will be vital to transforming our nation's healthcare system.
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