ICD-10 Compliance Date and End-to-End Testing Updates
ICD-10 Compliance Date
On April 1, 2014, the PAMA of 2014 (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S.Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015.The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through September 30, 2015.
July ICD-10 End-to-End Testing Canceled: Additional Testing Planned for 2015
CMS planned to conduct ICD-10 testing during the week of July 21 through 25, 2014, to give a sample group of providers the opportunity to participate in end-to-end testing with MACs and the CEDI contractor. The July testing has been canceled due to the ICD-10 implementation delay. Additional opportunities for end-to-end testing will be available in 2015.
Benefits of ICD-10
ICD-10 incorporates greater and specific data from clinical detail and specificity than ICD-9, and offers better support for care management, analytics, and quality measurement. ICD-10 will also improve the understanding of risk and severity. The modern classification system will provide much better data needed for measuring the quality, safety and efficiency of care and improve clinical, financial and administrative performance. Here are some examples of the benefits of ICD-10:
- ICD-10 CM specificity and detail have significantly expanded more than 68,000 codes; ICD-10-PCS significantly expanded more than 87,000 codes
- ICD-10 uses 4-7 digit alpha-numeric codes instead of the 4-5 digit numeric codes used in ICD-9.
- ICD-10 provides new tabulation lists.
- ICD-10 transfers conditions among the classifications. It may be necessary to search for conditions in various sections.
- ICD-10 utilizes "includes notes" and two types of "excludes notes.
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Frequently Asked Questions
- Will there be structural differences between ICD-9-CM and ICD-10-CM diagnosis codes?
Answer: Yes, there will be changes to the field length, the amount of codes available and the code composition will be different. Codes will generally be more specific and laterality is often identified.
- Where do we find the cheat sheets for most common codes used for certain providers?
Answer: You can contact your specialty society, they may be able to help you with ways you can focus on the particular codes that would be most beneficial to your practice.
- Will the CMS-1500 claim forms be changed to accommodate the new ICD-10 codes?
Answer: Yes, the NUCC revised the CMS-1500 claim form. The new form is version (02/12). Refer to News article “Revised CMS-1500 Paper Claim Form: Version 02/12” for additional information.
You can visit the National Uniform Claim Committee (NUCC) website to order the revised claim form and download the new instructions.
- Will we not be using lateral modifiers on the CPT codes since the ICD-10 codes will have them included?
Answer: There is no change to appending CPT procedure code modifiers.
- Will CPT codes change as well?
Answer: ICD-10-PCS (inpatient procedure coding) was developed by CMS for use in U.S. inpatient hospital settings only. The transition to ICD-10-CM PCS does not affect CPT codes, which will continue to be used for outpatient services.
- Will modifiers still be used?
Answer: Yes, there is no change to the procedure of appending modifiers.
- Will workers’ compensation and auto insurance companies which are considered noncovered entities have to switch to ICD-10-CM/PCS?
Answer: Workers' compensation and auto insurance companies are considered noncovered entities and are not covered under HIPAA, however since the ICD-9-CM codes will no longer be maintained after the implementation of ICD-10-CM/PCS it is recommended that that you use the new coding system.
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ICD-10 Training and Resources
MACs will not provide ICD-10 training for coding purposes. The resources provided below are for convenience only. National Government Services is not responsible for the content updates, maintenance, or fees associated with these external sites.
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Last Modified: 5/15/14