ICD-10-CM is a diagnosis classification and coding system developed by the Centers for Disease Control and Prevention (CDC) for use in all U.S. healthcare settings. ICD-10-CM (International Classification of Diseases, 10th Revision, and Clinical Modification) will replace the existing diagnosis code set: ICD-9-CM.
The U.S. Department of Health and Human Services mandated that all HIPAA-covered entities must implement ICD-10-CM for use in standard electronic transactions.
As of October 1, 2015, providers must:
- Submit outpatient claims with dates of service
- Submit inpatient claims with dates of discharge
- Claims submitted for service and discharge dates before October 1, 2015 should be coded using the ICD-9 coding standard
Additional information on ICD-10 is available at the Centers for Medicare & Medicaid Services.
> Submitting Claims
The following ICD-10 General Submission Guidelines align with CMS:
- Providers must submit ICD-9 codes for Dates of Service (DOS) or discharge prior to 10/01/2015. Claims containing ICD-10 codes for services prior to October 1, 2015, will be denied**. Providers will be required to re-submit these claims with the appropriate ICD-9 code.
** Exception: See section for specific billing guidelines on Inpatient Hospital & Other Bill Types Spanning Implementation Period
- Providers must submit ICD-10 codes for DOS or discharge on or after October 1, 2015. Claims containing ICD-9 codes for DOS on or after October 1, 2015 will be denied. Providers will be required to re-submit these claims with the appropriate ICD-10 code.
- We will deny all claims that are billed with both ICD-9 and ICD-10 diagnosis codes on the same claim.
- We will only accept ICD-10 codes composed of upper case characters. We will deny any claim that is submitted with ICD-10 codes composed of lower case characters or a mix of both upper and lower case characters.
View all ICD-10 General Submission Guidelines.
> The Impact to Providers
Implementation of ICD-10 will require considerable business and system changes throughout the healthcare industry. The ICD-10 conversion will significantly impact all segments of the health care industry due to:
- Increased specificity and numbers of codes, going from approximately 3,800 ICD-9 procedure codes to 87,000 procedure codes
- Expansion of diagnosis codes from 13,000 (ICD-9) to 68,000 (ICD-10)
- Changing from five-digit numeric codes (except for E and V) to seven-character alphanumeric codes
- Codes include designation of laterality (left and right)
- Chapters, categories, and titles have been restructured
- Combination diagnosis and symptom codes have been created
> The Benefits
The benefits of the ICD-10 conversion include:
- Accurate payments for new procedures not currently covered by ICD-9 coding
- Fewer rejected claims due to more specific, non-ambiguous code designations
- Improved patient disease management
- Synchronization of disease monitoring and reporting worldwide
> Additional Resources
Centers for Medicare & Medicaid Services (CMS) - Click here.
American Health Information Management Association (AHIMA) - Tools for the ICD-10 implementation
American Academy of Professional Coders (AAPC) - ICD-10 implementation and training information
Healthcare Information and Management Systems Society(HIMSS) - This ICD-10 Playbook page contains information about transitioning to ICD-10.
> Preparedness Survey Results
Please contact your Provider Relations Consultant if you have any questions related to ICD-10 testing.