ICD-10 Code Update

This federal policy change will require practices to begin utilizing the new sets of ICD-10 codes to document and report medical diagnoses for all clinical activity. As you would expect, this new federal requirement extends to laboratory diagnostics. We will be required to receive ICD-10 code sets from your office for specimens with a final collection date on or after October 1, 2015, as ICD-9 codes will no longer be recognized.

Everyone who is covered by Health Insurance Portability and Accountability Act (HIPAA) must transition to ICD-10 effective October 1, 2015. This affects all third party submissions to insurance companies for Medicare and private payers.

ICD-10 is a more robust system that allows for more detailed reporting. It allows for better tracking, recognizes current terminology and prepares the US for the future. This enhances the quality of data allowing for better tracking for public health conditions, measuring outcomes, comparing mortality and morbidity etc. Keep in mind, the United States in the only industrialized nation still using ICD-9 codes.

ICD-10 is federally mandated. If claims are not filed with ICD-10 codes, claims will be rejected and you will not be paid.

Only one code set will be accepted on a single claim. For claims with a date of service September 30, 2015 and before, use code set ICD-9. For outpatient claims with a date of service of October 1, 2015 and forward use ICD-10.

A text file of all ICD-10 codes and descriptions can be found on the CMS website: ICD-10 Codes and Descriptions

The Centers for Medicare & Medicaid Services (CMS) has stated that it will not accept claims using ICD-9 for discharges on or after October 1, 2015. From that date forward, only claims encoded using the ICD-10 code set will be accepted. Commercial payers and state Medicaid plans are also requiring providers to begin using the ICD-10 code set on October 1, 2015.

You can find more information on the World Health Organization´s website. In addition, visit CMS.gov where you can find where you can find other resources and guidance.