FAQS About ICD-10

FAQS About ICD-10

The fact that the ICD-9 coding is obsolete and is being replaced by ICD-10 has everyone in the healthcare system scrabbling to become compliant with the new system. Though it seems more complicated than the original coding system, ICD-10 will provide for better reimbursement rates for providers.

Here are some questions that you may have about the new way of billing inpatient procedures and services that you provide in your facility:

Why is the transitioning from ICD-9 to ICD-10 happening?

It has been determined that the ICD-9 system has limited data about patients’ medical conditions and their hospital inpatient procedures. The system is outdated, as it has been around for 30 years. It is inconsistent with current medical forms of practice. The structure of ICD-9 limits the addition of new codes to be created as many of its categories are full. ICD-10 ConsultantsICD-10 will allow for more diagnoses to be billed and is an important transformation of the entire health care system.

What are the consequences of not switching to ICD-10?

All claims for services and procedures must use ICD-10 codes on or after the deadline to be in compliance. This does not apply to outpatient procedures using CPT coding, however. If claims do not use the proper ICD-10 codes will not be processed unless the services and procedures were provided before the compliance date.

Why is ICD-10 different from any other annual code changes?

ICD-10 codes have a whole new structure that is different from ICD-9. So different, that it incorporates a new set of numbers that ICD-9 doesn’t. Where ICD-9 codes are basically numeric in design, the ICD-10 codes are alphanumeric and contain 3-7 characters. This will offer more descriptive coding where it will be easier to find the code that closely reflects a patient’s diagnoses.

What needs to be done in preparation for the new ICD-10 system?

The early a provider tests their ICD-10 systems, the better; this ensures that they are in compliance at the time the system is to be implemented. Beginning steps include:

• Testing of ICD-10 systems internally

• Working with payers to ensure everything is ready

• IT teams and data management to plan the launch of the system

So, do Medicaid programs also have to transition to ICD-10?

Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA), need to be compliant with the new ICD-10 system, Medicaid included.

How about it I don’t deal with Medicare claims? Do I have to transition at all?

As long as you are covered by the Health Insurance Portability and Accountability Act (HIPAA), you must be compliant with ICD-10. This means that providers and payers who do not work with Medicare claims still need to transition.

How long after the compliance date do I continue to report or process ICD-9 codes?

medical billing and coding companiesYou will have to check with the payer for their late filing requirements for transactions as such. ICD-10 does not require any changes to these requirements. As you well know, deadline requirements vary among the different plans.



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