On October 1, 2015, the ICD-9 code sets used to report diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition will affect all entities and providers covered by the Health Insurance Portability Accountability Act (HIPAA). This transition to a replacement diagnosis and inpatient procedure classification system may be challenging for providers given that ICD codes are recorded on many types of health records and are a key component in reimbursement, quality, utilization review, and other data management activities.
The following resources are designed to help physical therapists understand the transitional process and provide tips to ensure a smooth transition. For further information regarding ICD-10 issues, contact email@example.com.
Key Practice Impacts of ICD-10:
- Identification of where diagnosis codes are used today: Paperwork, electronic systems, and other processes, such as submitting reimbursement claims, identifying patient eligibility, getting prior authorization from a payer, reporting quality data, and more, will need to be updated to reflect new ICD-10 diagnosis codes.
- Documentation: The ICD-10 code set provides greater specificity for patient diagnosis, so it will be critical to assess current documentation and how it will support coding for ICD-10.
- Vendor Updates: If practices are using electronic systems for billing, they will need to have their systems updated by vendors.
- Staff Training: All staff that work with the current ICD-9 system must be trained on the ICD-10, such as clinicians, front desk staff, and coding/billing staff.
Coming Soon: APTA will soon be releasing clinical examples of physical therapy specific coding crosswalks to ICD-10.
- Webinar: ICD-10: Are You Ready to Move from ICD-9 to ICD-10 - 1/23/14
This webinar discusses the transition to ICD-10, walks providers through the ICD-10 coding process, and highlights key practice impacts and tips for the transition.
- CMS: ICD-10 Provider Resources
This page gives providers information regarding the ICD-10 transition, including an introduction to ICD-10, implementation guides, timelines, checklists, webinars, and more.
- CMS: ICD-10 Testing for Providers
This MLN Matters article instructs all Medicare Administrative Contractors (MACs) to test ICD-10 implementation with trading partners, such as providers, during the week of March 3 through March 7, 2014.
ICD-10 Official Guidelines
- CMS: 2014 ICD-10-CM and GEMs
The Centers for Medicare and Medicaid Services (CMS) has developed a bidirectional crosswalk, referred to as the General Equivalence Mappings (GEMs), between ICD-9-CM and ICD-10-CM/PCS. There are GEMs for over 99 percent of all ICD-10-CM codes and for 100 percent of the ICD-10-PCS codes.