FAQs

All your ICD-10 questions answered here.

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What is ICD-10?

Created by the World Health Organization (WHO), ICD-10 is the tenth revision to the International Classification of Diseases.

Why is ICD-10 replacing ICD-9?

According to CMS, in addition to being 30 years old, outdated, and inconsistent with current medical practice, ICD-9 produces limited data about patients' medical conditions and hospital inpatient procedures. Also, because of ICD-9's structure, there are only so many codes available and many of the categories are full.

On the other hand, the ICD-10 codes allow practitioners "greater specificity and exactness in describing a patient's diagnosis and in classifying inpatient procedures." Furthermore, ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems, and more accurate billing. Finally, ICD-10 is supposed to streamline billing processes and make it easier for CMS to detect fraud.

What's the difference between ICD-10-CM and ICD-10-PCS?

ICD-10-CM is the diagnosis classification system. The Centers for Disease Control and Prevention developed it for use in all US healthcare treatment settings. Diagnosis coding under this system uses three to seven alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM.

ICD-10-PCS, on the other hand, is the procedure classification system that the Centers for Medicare & Medicaid Services (CMS) developed for use in US inpatient hospital settings only. The new procedure coding system uses seven alpha or numeric digits while the ICD-9-CM coding system uses three or four numeric digits.

Is the US the first country to transition to ICD-10?

No; Australia and Canada are among several countries that have already transitioned to ICD-10. There are several important lessons we can learn from their transitions.

Who made the transition?

All practitioners who are covered by the Health Insurance and Portability Accountability Act (HIPAA)—whether or not they submit Medicare or Medicaid claims—must use the ICD-10 diagnosis codes as of October 1, 2015.

When should I use ICD-10 codes?

You must use ICD-10 codes for all claims with dates of service on or after October 1, 2015. You should use ICD-9 codes for claims with dates of service falling on September 30 or earlier, regardless of when you submit the claim.

Do ICD-10 codes replace CPT codes?

ICD-10 codes are diagnostic codes whereas CPT codes are billing codes. According to this APTA article, CPT codes will change for hospital inpatient billing, but outpatient providers and other clinicians will continue to use the existing CPT codes.

Do I use ICD-10 codes for auto and workers' compensation claims?

Because workers' comp and auto insurers are not HIPAA-covered entities, the national ICD-10 mandate does not apply to them. Thus, they can legally continue to use ICD-9 if they choose to do so. However, some states may require universal use of ICD-10, and leaders in the healthcare space—including CMS—strongly encourage workers' comp and auto insurance payers to voluntarily use ICD-10 codes. So, you'll need to contact the companies you work with directly to verify whether they transitioned to ICD-10.

Do my EMR and billing software handle the new codes?

Yes, WebPT offers intelligent built-in ICD-10 functionality. If you are not using WebPT, you should ask your vendor this question immediately.

How can I learn about CMS updates?

Visit www.cms.gov/ICD10 and sign up for the CMS ICD-10 email updates to receive the latest news and resources on ICD-10. You can also follow CMS on Twitter, and we'll share updates on this site.

What other resources are available?
  • Regional extension centers (RECs)—62 across the country—are helping small practices transition to EMR/EHR.
  • The APTA is releasing new ICD-10 information as it becomes available.
  • CMS has many ICD-10 resources available, including general information, latest news, checklists, and an implementation timeline.
  • Vendors, specifically EMR/EHR and billing, will provide resources—like the articles and information you'll find on the WebPT Blog—to make the transition easier.
  • You can also refer to this website; we'll post news, updates, how-tos, and advice.

Have a Question?

Like Woody Harrelson in ZombieLand, Heidi Jannenga is a bit of an expert—only her strong suit is ICD-10. So fire away. She's ready to answer all your ICD-10 questions.
Heidi Jannenga
PT, DPT, ATC/L
Resident ICD-ocalypse Expert

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