All entities covered by Health Insurance Portability and Accountability Act (HIPAA) are required to adopt ICD-10.

ICD-10 will enhance the healthcare system by enabling physicians to better capture patient visit details and more specifically identify patient problems including their degree and cause. This will ultimately lead to better care coordination and health outcomes.

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Essentially, ICD-10 will impact everything: Patient registration, authorization and pre-certification, referrals, clinical documentation, manuals, superbills, coding, payor relationships, patient hospital encounters and admissions, physician orders, research participation, staffing, billing, payments, and cash flow.

No, the change to ICD-10 doesn’t affect CPT coding for outpatient procedures and physician services.

ICD-10 codes allow doctors to specifically define diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injuries and diseases.

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ICD-10-CM (Clinical Modification) has 68,000 codes. ICD-10-PCS (Procedure Coding System) has 87,000 codes.

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For CM (Clinical Modification), the code structure is as follows:
The code is 3-7 characters long. The first character is an alpha character (other than “U”). The second character is numeric. These two first characters together describe the code’s category. Characters 3-7 can be any combination of alpha or numeric characters. They describe the etiology, anatomical site, and severity of the code, while character 7 serves as an extension code, if needed. A decimal is placed after the third character.

For PCS (Procedure Coding System), the code structure is as follows:
The code is 7 alphanumeric characters long. The first character identifies the section or type of procedure. The second character identifies the body system or anatomical region the procedure is taking place in. The third character identifies the root operation or objective of the procedure. Character four identifies the body part or specific anatomical site of the procedure. Character five identifies the approach or technique used during the procedure. The sixth character identifies any devices left at the operative site, and character seven identifies qualifiers for any additional information. As not all procedures involve leaving devices at the operative site and there will not always be additional information, characters six and seven can be filled in with a Z. There are no decimals in ICD-10-PCS codes.

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ICD-10 took effect October 1, 2015.

You’ll need to run a dual system for a time. Claims with a service date before October 1, 2015 will be submitted using ICD-9. Claims with a service date on or after October 1, 2015 must be submitted with ICD-10 coding.