ICD-10 overview

The transition to ICD-10 occurred on Oct. 1, 2015. As a HIPAA-mandated code set, all covered entities (physicians, other health care providers, payers and clearinghouses) must use ICD-10 to be in compliance with HIPAA. (Note: Property and casualty, auto and workers’ compensation insurance are not covered entities and are therefore not required to comply with HIPAA. State law dictates whether they are required to use ICD-10 or continue to use ICD-9.) 

Updates to the ICD-10 code set are made yearly and are effective Oct. 1.

If you encounter any issues with a payer, clearinghouse or other provider not in compliance with the current ICD-10 codes, contact the organization and attempt to resolve the issue. If you are unable to resolve the issue with the organization, you can file a complaint with the Centers for Medicare & Medicaid Services (CMS), the enforcer of HIPAA code sets.

Three months before the Oct. 1, 2015 deadline, CMS and the AMA announced efforts to continue to help physicians prepare for ICD-10. Read about CMS’s response to AMA concerns, as well as CMS’s Clarifying Questions and Answers (PDF) document.

The AMA has long advocated for physicians by voicing concerns with the code set to powerful stakeholders and policymakers. Read the most recent advocacy letters, calls, responses and testimonies.

The AMA and Centers for Medicare & Medicaid Services (CMS) provide a number of ICD-10 resources.

• Improving Your ICD-10 Diagnosis Coding (PDF)
• The Differences Between ICD-9 and ICD-10 (PDF)

You can also visit the CMS website for additional information.

The AMA Store offers training materials and other resources to help you understand and assign ICD-10 diagnostic and procedural codes. Our books are available in print and eBook format. Choose from among the following or view all of our ICD-10 offerings:

• ICD-10-CM and ICD-10-PCS codebooks with official guidelines to help you stay up to date on all of the latest codes.
• Chronic disease coding cards that make excellent risk adjustment coding tools for those mapping to hierarchical condition category (HCC) codes.
• ICD-10 resources for in-depth guidance on documentation, anatomy and physiology and the principles behind the code set.
• Specialty-specific coding cards for ICD-10-CM and a quick reference tool to explain how to build an ICD-10-PCS code.
• Data files that allow facilities to add ICD-10 codes to their software.

AMA store resources

• AMA store
• eBooks
• ICD-10-CM/PCS
• ICD-10-CM 2018 Codebook
• ICD-10-PCS 2018 Codebook
• ICD-10-CM 2018 Chronic Disease Coding Cards: Multiple Specialties
• ICD-10-CM Documentation 2018
• Anatomy and physiology
• Principles of ICD-10 4th Edition Package
• ICD-10-CM 2018 Snapshot Coding Cards: Multiple Specialties
• Quick reference
• ICD-10 2017 Data File