U.S. health care organizations are moving from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The codes are used to report medical diagnoses and inpatient procedures for payments. On April 1, 2014, President Obama signed into law a bill that delays ICD-10 implementation to begin no sooner than October 1, 2015.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note that the change to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures and physician services.
Please send any inquiries regarding ICD-10 to firstname.lastname@example.org.
These FAQs provide an overview of the transition to ICD-10 and points to resources for more information.
1. What is ICD-10?
ICD-10 stands for International Classification of Diseases, 10th Edition. As with ICD-9, it is a coding system for descriptions of diseases and clinical states, but with more detail and specificity:
2. Why ICD-10?
The current version, ICD-9, was adopted in 1979. Many changes and improvements have occurred over the past 36 years and the ICD-9 code length isn’t long enough to accurately describe and categorize all the advances of modern medicine. ICD-10 codes provide for more specificity and more descriptive language for the care we provide our patients.
3. Who needs to use ICD-10?
All L.A. Care Providers. Everyone who documents or bills for clinical care will need to use ICD-10 codes where these codes are required. This includes L.A. Care Providers, PPGs, IPAs, MSOs and Plan Partners.
4. Where will ICD-10 codes be required?
ICD-10 codes will be required at any location where you are currently using ICD-9 diagnosis and procedure codes. Examples include: encounters and claim forms, diagnosis and problem lists and authorizations where ICD-9 diagnosis and ICD-9 procedure code is requested. Electronic Medical Record (EMR) and applications should be prepared to accept ICD-10 codes on or before October 1, 2015. All paper forms you use will be revised for ICD-10 codes.
5. You will be required to bill on the new 1500 (02-12) form.
The new CMS 1500 was updated to allow diagnosis code field for up to 12 diagnoses and to accommodate ICD-10 alpha/numeric characters and the length of the codes.
6. When will we need to start using ICD-10?
Thursday, October 1, 2015. As of this date, all forms and documentation that require ICD-9 diagnosis or ICD-9 procedure code will need an equivalent ICD-10 code. Be prepared for all coding to be in ICD-10 format as of this date. Please note the change to ICD-10 does not affect Current Procedure Terminology (CPT) coding for outpatient procedures and physician services.
7. How can we find an ICD-10 code?
Just as you use various indexes to locate an ICD-9 code today, the same will be available for ICD-10. ICD-10 codes can be found through a number of different computer applications, electronic tools and published coding books. Electronic medical record systems, coding tools and online code lookup services are commonly used as well. If you are not sure if your ICD reference tools are ready for ICD-10, please contact your current vendor/provider to ensure you have the latest version that includes current ICD-10 codes.
8. Are there any guidelines that assist with the mapping between ICD-9-CM and ICD-10-CM and ICD-10-PCS?
Yes, there are several regulatory references. For Medi-Cal, please use this link: ICD-10: FAQs
9. When will providers be able to request pre-authorization of services using ICD10 diagnosis and procedure codes?
We will begin accepting and processing preauthorization requests containing ICD-10 codes August 10, 2015. Please note, that this is only for services scheduled on or after the compliance date. ICD-9 codes must be used to pre-authorize services scheduled before the compliance date.
10. Will you be ready to accept ICD-10-CM (Clinical Modification) and ICD-10-PCS (Procedure Coding System) codes on the compliance date?
Yes. Our systems supporting business processes, policies and procedures will be ICD-10 compliant as mandated, without interrupting day-to-day business operations and practices. We will be capable of accepting and processing ICD-10 diagnosis and procedure codes on the compliance date. Any claim submitted with ICD-9 codes for dates of services after 10/1/15 will be rejected.
11. How many pre-authorization requests will we need to submit for services that start on or before September 30, 2015 and extend through or beyond October 1, 2015?
If you have a member receiving services that starts prior to October 1, 2015 and will continue after October 1, 2015, you will need to submit two different authorization requests: one for dates of service through Sept 30, 2015 and one for dates of service from Oct 1, 2015 and after.
12. Will re-authorizations or continued services require ICD-10 codes for claims dates of service on or after October 1, 2015?
L.A. Care will honor all current authorizations through expiration date but not to exceed April 1, 2016. However, be aware that any authorization expiring after April 1, 2016 must be resubmitted using ICD-10 code set. For the new authorizations, providers are not required to wait until end of authorization to do this resubmission. Providers may submit new authorizations using the ICD 10 code set any time before April 1, 2016.
13. Will claims that include ICD-10-CM or ICD-10-PCS codes be accepted prior to the compliance date?
No. Claims with dates of service prior to October 1, 2015 and submitted using ICD-10-CM or ICD-10-PCS codes will not be accepted. Outpatient and inpatient claims with dates of service prior to the compliance date must be filed using the appropriate ICD-9 diagnosis and procedure codes. Inpatient claims for admissions that span the ICD-10 transition date (admitted prior to 10/01/2015 and discharged on or after 10/01/2015) must adhere to CMS guidance as detailed in MLN Matters Number SE1408. Please refer to the CMS website for additional information related to the ICD-10 compliance date and how to handle claims that span the transition date.
14. Where can providers find training opportunities?
ICD-10 resources are available through CMS, Medicare Administrative Contractors (MACs), professional associations and societies (such as AHIMA and the American Academy of Professional Coders), and practice management system/EHR vendors.
Medi-Cal Provider Training Site
15. Where can I learn more about ICD-10-CM and ICD-10-PCS?
Centers for Medicare and Medicaid Services (CMS)
National Center for Health Statistics (NCHS)
WEDI (Workgroup for Electronic Data Interchange)