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ICD-10 went live on October 1, 2015. Make sure you're up to speed with our ICD-10 Page!
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
The NYACP has plenty of resources and updates on the upcoming ICD-10 implementation, all found on this page.
9.15.16 - ICD-10 Toolkit Available to Assess and Maintain Compliance
The ICD-10 Assessment and Maintenance Toolkit is now available from CMS to help you maintain your ICD-10 progress. This in-depth toolkit shows how you can manage your revenue cycle by:
- Assessing ICD-10 progress using Key Performance Indicators (KPIs) to identify potential productivity or cash flow issues
- Addressing opportunities for improvement
- Maintaining progress and keeping up-to-date on ICD-10
The toolkit is also available as an infographic with an accompanying fact sheet on KPIs to help you analyze and track your ICD-10 progress. Visit the ICD-10 website for the latest news and official resources, including the Quick Start Guide and a contact list for provider Medicare and Medicaid questions.
Attention Paper Claim Submitters: Changes Due to the Implementation of ICD-10
With the implementation of ICD 10 on 10/1/2015, it is important to use the appropriate ICD Indicators on claim submissions.
The “ICD Indicator” identifies the ICD code set being reported. It is imperative that you enter the applicable ICD indicator according to the following:
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Indicator
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Code Set
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9
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ICD-9-CM Diagnosis
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0
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ICD-10-CM Diagnosis
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- Dates of service 10/1/2015 and after, the ICD-10-CM indicator should be “0.”
- Dates of service 9/30/2015 and prior, the ICD-9-CM indicator should be “9.”
- Line item 21 on the CMS 1500 claim form or the electronic equivalent shall be submitted with the appropriate indicator of “0” for ICD-10-CM or “9” for ICD-9-CM.
Item 21
ICD-10 Is Here! Make Sure Your Practice is Ready with These Great Resources
It's been several days since the implementation of ICD-10, and to ensure a smooth transition to the new coding system, here's a quick checklist of what should be done in this month:
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Make sure diagnosis is consistent with the procedure (age, gender, provider type, and so on).
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Be sure the code is valid? For Medicare FFS, it must at least be the right "family" - but for private payers and Medicaid, it needs to be as specific as possible. Use a book or electronic tool to confirm valid vs. invalid codes.
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Use the CMS free look-up tool and ACP's downloadable "Commonly Used ICD-10-CM Codes" list.
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Keep medical necessity in mind. Does the code used support the CPT code? While this is nothing new, it is something to be hyper-vigilant about in the beginning.
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Be aware of referrals and authorizations that used ICD9 codes. Map back to ICD9 if necessary. Double check date of service and use correct code set.
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Track denials carefully – learn from mistakes and resubmit claims as soon as possible. Follow-up with payer as needed.
- Contact payer representatives for problem payers.
For problems, contact the ICD-10 Ombudsman at: ICD10_ombudsman@cms.hhs.gov or get more information on how to contact the ICD-10 Ombudsman.
Coding and Clinical Documentation Resources
Official government coding guidelines cover:
CMS offers documentation and coding basics for clinicians in the Road to 10 Clinical Concepts Series with tailored guidance for:
Free lists of codes and ICD-9/ICD-10 mappings are available from CMS for example:
Tips to Get Ready for ICD-10: A Timeline
September 2015
- Create a short list of your most common ICD 9 codes and map to ICD 10 codes. Share with clinicians and billing staff. This ACP list is a starting place, or use these specialty references from CMS.
- Don't let staff – especially billing staff – take vacation in October, and possibly into early November. There WILL be denials and delayed payments – plan on a backlog in the collection department. Review your denial process, and verify roles and responsibilities. Staff up or pay overtime if needed.
- Get all ICD-9 claims out the door by the end of the day on September 30. Date of service, NOT date of submission, is the key driver, but getting all ICD-9 codes out by Sept 30 will reduce errors from humans (and computers) switching between code sets. This might require clinicians and billers to stay late to finish charts and post claims. CMS will not accept ICD-9 codes for dates of service starting 10/1/15.
- Line up temporary help during the early weeks after October 1. Plan on a slow-down in clinician productivity (due to spending extra time documenting and coding), in claims (due to missing information on codes), and in collections (due to payer denials or delays). If you have part-timers, put them on stand-by before someone else does.
- Plan for extra-long phone holds for claims follow-up, pre-authorizations, and other insurance activities.
- "Shadow code" 3-5 claims every day until Oct 1. Pick common procedures and types of patients and code in both 9 and 10 – check if documentation is adequate for ICD-10-CM.
- For home health or other codes that will begin BEFORE Oct 1 and end AFTER October 1, be sure and bill the ICD-9 part on Sept 30 and the ICD-10 part upon discharge. Go to cms.gov for guidance.
- Watch for payer communications regarding ICD10 – every payer will have different protocols. Contact payer representatives BEFORE Oct 1. Schedule a time to send test claims if possible.
- Find out whether your state Medicaid and worker's comp payers are ready.
- Consider what metrics your practice wants to monitor after October 1, such as physician productivity, coder productivity, billing and A/R metrics, denial reports, or number of times physicians need to be queried regarding their documentation. This will provide guidance as to where training and tools are needed most.
October 2015
- Make sure diagnosis is consistent with the procedure (age, gender, provider type, and so on).
- Is the code valid? For Medicare FFS, it must at least be the right "family" but for private payers and Medicaid, it needs to be as specific as possible. Use a book or electronic tool to confirm valid vs. invalid codes.
- Keep medical necessity in mind. Does the code used support the CPT code? While this is nothing new, it is something to be hyper-vigilant about in the beginning.
- Be aware of referrals and authorizations that used ICD9 codes. Map back to ICD9 if necessary. Double check date of service and use correct code set.
- Track denials carefully – learn from mistakes and resubmit claims as soon as possible. Follow-up with payer as needed.
- Contact payer representatives for problem payers.
- For problems, contact the ICD-10 Ombudsman at ICD10_ombudsman@cms.hhs.gov or get more information on how to contact the ICD-10 Ombudsman.
WCB Issues Guidance for Complying With ICD-10 as of October 1
The New York State Workers Compensation Board today issued a bulletin to set forth how it will implement the use of ICD-10 codes as of October 1. To read the bulletin, click here.
The bulletin notes that “to promote consistency between medical systems and to avoid imposing significant costs to support multiple systems, the Board will require use of ICD-10 consistent with CMS for dates of service after 10/1/15. In particular, the Bulletin notes the following:
- Providers may not submit a combination of ICD-9 and ICD-10 codes on the same bill. Separate bills must be submitted for dates of service on or before September 30, 2015 and on or after October 1, 2015.
- In the event a provider has not completed the full transition to ICD-10, medical bills shall be processed and paid regardless.
- Carriers must accept both ICD-9 codes and ICD-10 codes effective October 1, 2015. Provider miscoding, such as the use of ICD-9 codes for dates of service on or after October 1, 2015, or the use of ICD-10 codes for dates of service prior to October 1, 2015, are not valid reasons to deny or reduce a medical bill.
- In order to ease the transition to ICD-10, the Board will accept the CMS-1500 (or HCFA-1500) form with a detailed narrative report or office note effective October 1, 2015. Authorized physicians, podiatrists, and chiropractors statewide may submit a CMS-1500 with a detailed narrative report or office note in lieu of C-4 or C-4.2 forms. If a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A narrative report or office note is considered detailed when it contains the necessary information for the insurance carrier to properly process the submission. The narrative attachment requirements can be found on the Board’s website.
New ICD-10 Coding and Clinical Documentation Resources!
As with ICD-9, ample resources are available to assist you with coding and clinical documentation for ICD-10.
Official government coding guidelines cover:
Free lists of codes and ICD-9/ICD-10 mappings are available from CMS as well as vendors and trade associations, for example:
Several free and low-cost smartphone apps are available, and ICD10Data.com is a mobile-friendly website.
Many electronic health record (EHR) products and practice management systems prompt users for required documentation and feature computer-assisted coding.
Some system vendors and clearinghouses offer training to customers and potential customers.
Some health care trade associations and medical societies provide coding resources at no or little cost to their members, with premium costs sometimes charged to nonmembers.
Membership is not required to submit coding questions to the American Hospital Association’s codingclinicadvisor.com or view AHA’s free webinars (registration is required). When contacting the Coding Clinic Advisor for free assistance, include documentation and specify whether your question refers to a specific setting like a skilled nursing facility or home health services. Please note that the Coding Clinic Advisor will not respond to inquiries that include personal health information (PHI) or the names of providers or health care facilities. Please see the Coding Clinic Advisor FAQs for more, including a list of topics that are out of scope for this service.
Remember: The process for looking up an ICD-10 code—whether in a book or in an electronic product—remains essentially the same as the process for looking up an ICD-9 code.
Latest CMS Announcement and FAQ Regarding ICD-10
In early July, the Centers for Medicare & Medicaid Services (CMS) announced that for a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. CMS will also establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
If you have any questions regarding this announcement, please read this FAQ.
Road to 10
The Centers for Medicare & Medicaid Services (CMS) has released a webcast introducing the "Road to 10" tool. Accessible through this link, the webcast covers the history of the International Classification of Diseases (ICD) and the benefits of ICD-10. This is the first in the new "Road to 10" webcast series. Five more webcasts will follow-all aimed at helping small practices get ready for ICD-10 by the October 1, 2015, compliance date.
Also available now is a brief video introduction to the "Road to 10" tool. Developed in collaboration with physicians, the "Road to 10" tool offers:
- Clinical documentation tips
- Coding concepts
- Clinical scenarios
- Training calendar
Go to the CMS ICD-10 website to get started on the "Road to 10" today.
CMS YouTube Videos for ICD-10
The Centers for Medicare & Medicaid Services (CMS) has released many videos to help ease your transition as we count down to ICD-10 implementation. The videos and links are listed below.
Internal Medicine Clinical Concepts Guide for ICD-10 Available Now!
To help physicians and other providers get quickly up to speed for ICD-10, CMS is launching the Clinical Concepts Series for specialties.
Posted on the CMS ICD-10 website, each guide in the series compiles key information from the Road to 10 online tool in a PDF format that can be readily shared, emailed, posted to websites, and printed.
Each guide includes:
- Common ICD-10 codes and corresponding ICD-9 codes
- Clinical documentation tips
- Clinical scenarios
- Links to interactive cases studies, in-depth webinars, and other Road to 10 features
CMS has released Clinical Concepts for Internal Medicine, which highlights ICD-10 concepts for conditions like chest pain, headache, heart disease, and more.
Upcoming guides will focus on cardiology, pediatrics, OB/GYN, and orthopedics. Stay tuned!
Keep Up to Date on ICD-10
Follow these sites to keep up-to-date on ICD-10!
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