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: Final Steps for Successful Implementation
This course will prepare you for the October 1, ICD-10 implementation mandated by the government. (FREE to members)
- 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 (.pdf)
The testing program will be held over 3 separate weeklong sessions—one this November 17-21, and 2 in 2015, March 2-6 and June 1-5. Members only need to sign up for 1 session to find out whether their Medicare administrative contractor (MAC) will be able to accept claims with the new codes. The MACs will post information on how to participate in the tests.
- CMS: International Classification of Diseases, 10th Revision (ICD-10) Testing - Acknowledgement Testing with Providers (.pdf)
This article was revised on February 27, 2015, to reflect the revised CR8858, issued on February 24. In the article, the CR release date, transmittal number, and the Web address for accessing CR8858 are revised. All other information remains the same.
ICD-10 Official Guidelines
CMS ICD-10-CM and GEMS
- CMS: 2014 ICD-10-CM and GEMs
The Centers for Medicare and Medicaid Services (CMS) provides electronic files for ICD-10-CM code. Althought not recommended to use independently, 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.