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ICD-10 Transition Set for October 1, 2014


11/12/2013

The transition date from ICD-9 to ICD-10 coding across all health care settings is October 1, 2014, as announced in a final rule on ICD-10 compliance issued by the Centers for Medicare & Medicaid Services (CMS) (77 Fed. Reg. 54664 [September 5, 2012]). On this date, ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition will require business and systems changes throughout the health care industry, as it applies to all providers and settings subject to the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.  Although there have been previous delays, CMS advises that the compliance dates are now firm with no grace period for implementation, and are not subject to change.  If providers are not ready or do not comply, Medicare will not process or pay their claims.  Preparing now can help avoid potential reimbursement issues later.

ICD-10-CM diagnosis codes will apply to all providers in every health care setting.  You must begin using the ICD-10-CM codes to report diagnoses from all ambulatory and physician services on claims with dates of service on or after October 1, 2014, and for all diagnoses on claims for inpatient settings with dates of discharge that occur on or after October 1, 2014.

ICD-10-PCS procedure codes will be used only in inpatient hospital settings. You must begin using the ICD-10-PCS codes for all hospital claims for inpatient procedures on claims with dates of discharge that occur on or after October 1, 2014.

The transition does not affect coding for outpatient procedures and physician services (including occupational therapy services); there will be no impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.  You should continue to use these codes for outpatient therapy services.  (Physician claims for services provided to inpatient patients will also continue to report CPT and HCPCS codes.)

The differences between the ICD-10 code sets and the ICD-9 code sets are primarily in the overall number of codes, their organization and structure, code composition, and level of detail.  There are approximately 70,000 ICD-10-CM codes compared to approximately 14,000 ICD-9-CM diagnosis codes, and approximately 70,000 ICD-10-PCS codes compared to approximately 4,000 ICD-9-CM procedure codes.  In addition, ICD-10 codes are longer and use more alpha characters, which enable them to provide greater clinical detail and specificity in describing diagnoses and procedures.  Also, terminology and disease classification have been updated to be consistent with current clinical practice. 

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