ICD-10

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 advocacy@apta.org.

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.

General Information

  • 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

  • CDC: ICD-10-CM Official Guidelines for Coding and Reporting (2014)

    As with ICD-9-CM, ICD-10-CM is supplemented by a set of "Official Guidelines" that are designated as part of the ICD-10-CM code set by the HIPAA “medical data code set” regulations (45 CFR § 162.1002(C)(2)). The Official Guidelines provide detailed guidance on the use of the ICD-10-CM code set.

GEMS

  • 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.

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