What is ICD-10?

ICD stands for International Classification of Diseases and is a set of codes used by medical providers to standardize the way a diagnosis is recorded. The current version is ICD-9 with the “9” indicating that it is the 9th edition.

ICD-10 is the 10th edition, and the change was necessary for a number of reasons. ICD-9 limited the amount and types of data that could be collected, is over 30 years old, and the number of codes that can be created is at its limit.

There are two types of ICD-10 codes: ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding. The new version will accommodate close to 69,000 codes and allows for the notation of new diagnoses.

What’s Next for ICD-10

This past April, the compliance date for ICD-10 was pushed from October 1, 2014 to October 1, 2015. Billing and reimbursements are a critical concern for providers, and the nature of the delay has caused uncertainty and confusion for many practices.

After years of delays, it now appears that the October 2015 date is indeed the true launch date. While larger health systems have had the capital to invest in the conversion, many smaller practices are still struggling with when and how to approach the change. ICD-10 is a more complex system and will require more training and expertise to ensure reimbursements are coded properly.

For the time being, practices are being forced to run both systems and gradually gain experience with ICD-10 ahead of the permanent change.

What caused the delay?

On April 1st, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, mandating the Secretary of Health and Human Services not adopt ICD-10 prior to October 1st 2015.

The previous implementation date of ICD-10 was October 1, 2014 but after pressure from groups like the AMA, congress decided to delay the start date until October 1, 2015. The concept behind the delay was to give practices more time to prepare, and pay for, the costs associated with the change. While the extra time is helpful, the uncertainty surrounding the deadline is not, and many practices are struggling to know when to make the change.

What does the delay mean for your practice?

The latest change requires HIPAA covered entities to continue to use ICD-9-CM through September 30th, 2015. Many third-party payers have already posted ICD-10 codes in coverage policies to take effect October 1st of this year and are in the process of changing policies to have both ICD-9 and ICD-10 until September 30th, 2015.


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