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July 17, 2015
ICD­10 Transition
Preparation and Preparedness
ICD­10 Overview
ICD­10­CM/PCS (International Classification of Diseases, 10th Edition, Clinical
Modification/Procedure Coding System) consists of two parts: ICD­10­CM for diagnosis
coding and ICD­10­PCS for inpatient procedure coding.
The transition to ICD­10 is occurring because ICD­9 produces limited data about patients'
medical conditions and hospital inpatient procedures. ICD­9 is 30 years old, has outdated
terms, and is inconsistent with current medical practice. Also, the structure of ICD­9 limits
the number of new codes that can be created, and many ICD­9 categories are full.
ICD­10 CMS Update Plans for Implementation
CMS and AMA released on 7/6/2015 that Medicare will not deny any medical claims within
the first 12 months "based solely on the specificity of the ICD­10 Diagnoses code as long as
the practitioner used a valid code from the right family." CMS will also hire a CMS ICD­10
Ombudsman to help manage any questions regarding the submission of claims to help ease
the transition.
Who needs to transition?
ICD­10 will affect diagnosis and inpatient procedure coding for everyone covered by Health
Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or
Medicaid claims.The change to ICD­10 does not affect coding for outpatient
procedures.
How does the ICD­10­CM compares to the ICD­9­CM
ICD­10­CM uses 3­7 alpha and numeric digits and full code titles, but the format is very
much the same as ICD­9­CM (for example, ICD­10­CM has the same hierarchical structure
as ICD­9­CM).
The 7th character in ICD­10­CM is used in several chapters including, the Injury,
Musculoskeletal, and External Cause chapters. It has a different meaning depending on the
section where it is being used. An example of this is in the Injury and External Cause
sections, the 7th character classifies an initial encounter, subsequent encounter, or late
effect.

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Primarily, changes in ICD­10­CM are in its
organization and structure, code composition,
and level of detail.
ICD­9­CM Diagnoses Codes: ICD­10­CM Diagnosis Codes:
Are 3­5 digits;
The first digit is alpha (E or V) or
numeric
(aplha characters are not case
sensitive)
Digits 2­5 are numeric; and
A decimal is used after the third
character
Examples:
496­Chronic airway obstruction, not
elsewhere classfed (NEC) 511.9 ­
Unspecified pleural effusion; and
V02.661 ­ Hepatitis B carrier.
Are 3­7 digits;
Digit 1 is alpha;
Digit 2 is numeric;
Digits 3­7 are alpha or numeric (alpha
characters are not case sensitive); and
A decimal is used after the third
character.
Examples:
A78­Q fever;
A69.21 ­ Meningitis due to Lyme
disease; and
s52.131A ­ Displaced fracture of
neck of right radius, initial
encounter for closed fracture.
New Features For ICD­10­CM
The following new features can be found in
ICD­10­CM:
Laterality (Left, Right, Bilateral)
Examples: C50.511 ­ Malignant neoplasm of
lower­outer quadrant of right female breast;
H16.013 ­ Central corneal ulcer, bilateral; and
L89.012 ­ Pressure ulcer of right elbow, stage
II.
Combination Codes For Certain
Conditions and Common Associated Symptoms and Manifestations
Examples: K57.21 ­ Diverticulitis of large intestine with perforation and abscess with
bleeding; E11.341 ­ Type 2 diabetes mellitus with severe nonproliferative diabetic
retinopathy with macular edema; and I25.110 ­ Atherosclerotic heart disease of native
coronary artery with unstable angina pectoris.
Combination Codes for Poisonings and Their Associated External Cause
Example: T42.3x2S ­ Poisoning by barbiturates, intentional self­harm, sequela.

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Obstetric Codes Identify Trimester Instead of Episode of Care
Example: O26.02 ­ Excessive weight gain in pregnancy, second trimester.
Character "x" is Used as a 5th Character Placeholder in Certain 6 Character Codes
to Allow for Future Expansion and to Fill in Other Empty Characters (For Example,
Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length
Requires a 7th Character
Examples: T46.1x5A ­ Adverse effect of calcium­channel blockers, initial encounter; and
T15.02xD ­ Foreign body in cornea, left eye, subsequent encounter.
Two Types of Excludes Notes
Excludes 1 ­ Indicates that the code excluded should never be used with the code
where the note is located (do not report both codes). Example: Q03 : Congenital
hydrocephalus. Excludes 1: Acquired hydrocephalus G91.
Excludes 2 ­ Indicates that the condition excluded is not part of the condition
represented by the code but a patient may have both conditions at the same time, in
which case both codes may be assigned together (both codes can be reported to
capture both conditions). Example: L27.2 ­ Dermatitis due to ingested food. Excludes 2:
Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4).
Inclusion of Clinical Concepts That Do Not Exist in ICD­9­CM (For Example,
Underdosing, Blood Type, Blood Alcohol Level)
Examples: T45.526D ­ Underdosing of antithrombotic drugs, subsequent encounter; Z67.40
­ Type O blood, Rh positive; and Y90.6 ­ Blood alcohol level of 120 ­ 199 mg/100 ml.
A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes,
Substance Abuse, Postoperative Complications)
Examples: E10.610 ­ Type 1 diabetes mellitus with diabetic neuropathic arthropathy;
F10.182 ­ Alcohol abuse with alcohol­induced sleep disorder; and T82.02xA ­ Displacement
of heart valve prosthesis, initial encounter.
Codes for Postoperative Complications Are Expanded and a Distinction is Made
Between Intraoperative Complications and Postprocedural Disorders
Examples: D78.01 ­ Intraoperative hemorrhage and hematoma of spleen complicating a
procedure on the spleen; and D78.21 ­ Postprocedural hemorrhage and hematoma of
spleen following a procedure on the spleen.
TMC & JBS Software Solutions
ICD­10 Transition Implementation Plan & Timelines
JBS Software Solutions Database Upgrades Complete to Allow for Concurrent
Utilization of ICD­9 & ICD­10 for Testing Purposes
JBS has already completed the internal testing phase.
June 2015
Begin entry of any LCD and crosswalks that have been entered for the MACs
Internal education to begin July/August 2015
Internal educational seminars initiated for TMC clinicians for ICD­10
utilization

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August 2015
All cases initiated in JBS will be selected
using the ICD­10 code and both the ICD­10
and the equivalent ICD­9 will display on
document.
All electronic information will continue to
ONLY contain ICD­9
CMS states there will be no testing
submission period prior to October 1, 2015
transition
There will be a query to double check to
ensure no outliers that are excessively long
cases.
September 15, 2015
All current patient data will now reflect ICD­10 codes in the database and on
documentation, as well as the ICD­9 codes.
Internal query to ensure all active cases are compliant with following:
ICD­9 and ICD­10 data for transition date
SupportingcCodes for any/all new crosswalk & LCD based on ICD­10
October 1, 2015
All information dated ON or AFTER October 1, 2015 will display ONLY ICD­10
information.
Tools and Guides to be Available Through TMC
Mapping Software Mapping Guide
Forward Map (ICD9 to ICD10) or
Backward Map (ICD10 to ICD9)
Keyword search functionality
JBS therapist interface
JBS Facility Portal for facility
staff
Nursing staff top 100 medical
diagnoses for geriatric population
Top 30 therapy related medical
diagnoses
Top 30 therapy related treatment
Sample of Mapping Guide
ICD­9 Code/Description ICD­10 Code/Description
486: Pneumonia organism unspecified J18.9 Pneumonia, unspecified organism
Extended
J18.8 Other pneumonia, unspecified
organism
492.0: Emphysematous bleb J43.9 Emphysema, unspecified
493.90: Asthma unspecified J45.909 Unspecified asthma, uncomplicated
J45.998 Other asthma
496: Chronic airway obstruction, not
elsewhere classified
J44.9 Chronic obstructive pulmonary disease,
unspecified
530.81: Esophageal reflux K21.9 Gatro­esophageal reflux disease
without esophagitis
558.9: Other and unspecified noninfectious
gastroenteritis and colitis
K52.89 Other specified noninfective
gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis,
unspecified

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Important Reminders:
Even if you submit your claim on or after the ICD­10 deadline, if the date of service was
before the October 1, 2015, deadline, you will use ICD­9 to code the diagnosis.
For dates of service on or after the October 1, 2015, deadline, you will use ICD­10. You may
not be able to use ICD­9 and ICD­10 codes on the same claim
based on your payers' instructions.
This may mean splitting services that would typically be captured on one claim into two claims:
one claim with ICD­9 diagnosis codes for services provided before October 1, 2015, and
another claim with ICD­10 diagnosis codes for services provided on or after October 1, 2015
Some trading partners may request that ICD­9 and ICD­10 codes be submitted on the same
claim when dates of service span the compliance date. Trading partner agreements will
determine the need for split claims.
Here's an example of a split claim:
A patient has an appointment on September 27, 2015, and is diagnosed with bronchitis. He
returns for a follow­up appointment on October 3, 2015. In this case, a practice will submit a
claim with an ICD­9 diagnosis code for the first visit and another claim with an ICD­10
diagnosis code for the follow­up visit.
Please contact us in the event you have any compliance concerns
Leslie Welch, RAC­CT/COTA
Senior Director of Reimbursement and Regulatory Compliance
Contact Info: (352)­382­1130 Email: corporatecompliance@therapymgmt.com
"We must become the change we want to see in the world"
Mahatma Gandhi
8477 S. Suncoast Blvd., Homosassa, FL 34446 PHONE: 800-804-9961 FAX: 352-382-1146