1) What is ICD-10 coding system?
ICD 10 is the tenth revision of the International Classification of Diseases,
implemented by the WHO (World Health Organization) in 1993. In the U.S,
with effect from October 1, 2014, ICD 10 will replace the current ICD 9
coding system. Unlike ICD 9 CM, ICD 10 consists of two parts:
-ICD-10-CM (Clinical Modification) used for diagnosis coding. This uses 3
to 7 digits, replacing the 3 to 5 digits used with ICD-9-CM
-ICD-10-PCS (Procedure Coding System) used for inpatient procedure
coding and uses 7 alphanumeric digits, replacing 3 to 4 numeric digits
used with ICD-9-CM
Claims for medical treatments provided on or after the implementation
date must use updated ICD-10 codes or those claims will be ineligible for
2) Why is the U.S. moving to ICD 10 CM?
The major reason behind the transition is that the ICD 9 code set is
outdated. The total number of codes in the ICD 9 code set implemented 30
years ago is insufficient to accurately describe the new diagnoses and
procedures in the current medical practice. This code set does not
accommodate the latest discoveries in medical science. Another reason is
the need for increased specificity. ICD-9 lacks specificity of the information
conveyed in the codes. For instance, if a patient is provided treatment for a
burn on the left arm, the ICD-9 diagnosis code does not distinguish that the
burn is on the left arm. Significantly different procedures are assigned to a
single ICD-9-CM procedure code. Quality of care cannot be measured
accurately. ICD 10 is a standard coding system with unique codes for
substantially different healthcare conditions.
3) What is the difference between ICD 9 and ICD 10?
There are some basic differences between the two systems.
3-5 characters in length
First digit alpha or
3-7 characters in length
First digit alpha, 2 and
3 numeric, 4-7 alpha or
4) Will ICD-10-PCS replace CPT codes in ICD 9?
No. Maintained by the Centers for Medicare and Medicaid Services (CMS),
ICD 10 PCS is designed to replace ICD-9-CM for inpatient procedure
reporting. The Current Procedural Terminology (CPT) and Healthcare
Common Procedure Coding System (HCPCS) will continue to be used to
report services and procedures in outpatient and office settings.
5) What is HIPAA 5010?
HIPAA ASC X12 version 5010 is a new set of standards that regulate the
electronic transmission of specific healthcare transactions including
eligibility, claim status, referrals, claims, and remittances. All healthcare
providers are required to conform to the new transaction set standards.
6) How can the medical office prepare for the transition?
The transition from ICD-9 code sets to ICD-10 will result in more details,
terminology changes and expanded concepts for laterality, injuries and
other related factors. Insurance payers will expect physicians to bill using
these more specific codes. According to AAPC, “ICD-10 implementation will
radically change the way coding is currently done and will require a
significant effort to implement.” The implementation of the 5010 standard
will also require changes to the software systems, and procedures currently
used to bill Medicare and other payers.
Comprehensive ICD-10 training should be provided to medical staff in order
to fully grasp the changes that accompany the new code sets. Medical billing
software currently in use must be updated to recognize the new coding
standards. Your software should be upgraded for the Version 005010
(5010) HIPAA transactions.
AAPC Certified medical billing and coding specialists at an established
medical billing company will be equipped to handle ICD 10 medical coding
requirements for all medical practices.