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ICD-10 Frequently Asked Questions

What is “ICD-10”?
“ICD-10” is the abbreviation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).

What is the difference between ICD-10-CM and ICD-10-PCS?
ICD-10-CM is the diagnosis code set that replaces ICD-9-CM Volumes 1 and 2. ICD-10-CM is used to report diagnoses in all clinical settings.

ICD-10-PCS is the procedure code set that replaces ICD-9-CM Volume 3. ICD-10-PCS is used to report hospital inpatient procedures only.

Will ICD-10-PCS replace CPT®?
No. ICD-10-PCS is used to report hospital inpatient procedures only. The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) continues to be used to report services and procedures in outpatient and office settings.

Do I have to upgrade to ICD-10?
Yes. The conversion to ICD-10 is a HIPAA code set requirement. Providers, including physicians, are HIPAA “covered entities,” which means that you must comply with the HIPAA requirements.

Who else has to upgrade to ICD-10?
Health care clearinghouses and payers are required to upgrade, as they are also HIPAA covered entities. Be aware, however, that workers’ compensation, property and casualty, and auto insurance are not HIPAA covered entities and are not required by federal regulation to convert to ICD-10. At the state level, many states—but not all—have set requirements for these payers to use ICD-10.

Why was ICD-9 replaced?
In short, the ICD-9 code set was over 30 years old and had become outdated. It was no longer considered usable for today’s treatment, reporting and payment processes, and it did not reflect advances in medical technology and knowledge. In addition, the format limits the ability to expand the code set and add new codes. ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000.

The ICD-10 code set reflects advances in medicine and uses current medical terminology. The code format is expanded, which means that it is able to include greater detail within the code. The codes are 3-7 characters in length and total 68,000. Greater detail allows the code to provide more specific information about the diagnosis. The ICD-10 code set is also more flexible and can be expanded to include new technologies and diagnoses. The change from ICD-9, however, is expected to be disruptive for physicians during the transition.

For additional background, download any of the free ICD-10 educational resources.

When do I have to convert to ICD-10?
The compliance date is Oct. 1, 2015, and all services and discharges on or after that date must be coded using the ICD-10 code set. The necessary system and workflow changes need to be in place by the compliance date in order for you to send and receive the ICD-10 codes.

For tips and tools to help you meet the Oct. 1 compliance date, download any of the free AMA ICD-10 implementation resources and tools.

What if I’m not ready by the compliance deadline?
Any ICD-9 codes used in transactions for services or discharges on or after the Oct. 1, 2015, compliance date will be rejected as noncompliant, and the transactions will not be processed. You will have disruptions in your transactions being processed and in receipt of your payments. Physicians are urged to set up a line of credit to mitigate any cash-flow interruptions that may occur.

What do I need to do now to prepare for the conversion to ICD-10?
The AMA offers free educational resources and implementation planning tools to help you prepare for the transition to ICD-10. Review these resources to determine which are applicable to your practice.

Learn more about ICD-10 and download the resources and documents to plan for the new coding set.