5 Basic Things You Need to Know About ICD-10

ICD-10 is Less Than a Year Away

Denise M. Mullin
Director of Information Technology
Mount Sinai Doctors Faculty Practice

  1. The difference between ICD-10-CM and ICD-10-PCS:
    ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is a coding system for classifying medical diagnoses. ICD-10-PCS (International Classification of Diseases, 10th Revision, Procedure Coding System) is a coding system for classifying medical procedures.
  2. Who will need to use ICD-10 codes:
    All entities that are covered by the Health Insurance Portability and Accountability Act (HIPAA) must use ICD-10 codes on all HIPAA transactions. ICD-10-CM codes (diagnoses) will replace the ICD-9-CM codes for all medical diagnosis coding (inpatient and outpatient). ICD-10-PCS codes (procedures) will replace the ICD-9-CM, Volume 3, procedure codes for inpatient procedure coding. CPT coding will remain for outpatient procedures.
  3. When ICD-10 codes will be mandatory:
    ICD-10 codes must be used on all HIPAA transactions by October 1, 2013. For claims transactions (X12 837) all outpatient claims with dates of service and inpatient claims with dates of discharge on and after October 1, 2013 must use ICD-10 codes.
  4. Why you need to transition to ASC X12Version 5010:
    Healthcare EDI transactions need to use ASC X12 version 5010. This version accommodates the new ICD-10 codes (Version 4010/4010A cannot accommodate ICD-10 diagnosis or procedure coding). EDI transaction sets include:

    • Claim/Encounter (X12 837)
    • Eligibility Inquiry and Response (X12 270/271)
    • Claim Status Inquiry and Response (X12 276/277)
    • Referrals and Prior Authorizations (X12 278)
    • Payment and Remittance Advice (X12 835)
    • Claim Attachments (X12 275)
  5. When Version 5010 will be mandatory:
    Version 5010 will replace the current version 4010/4010A. All HIPAA covered entities must transition to Version 5010 by January 1, 2012for all electronic transactions for which a standard has been adopted. Important dates regarding the V5010 implementation:

    • December 31, 2010: Level I Compliance (“that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing.”)
    • December 31, 2011: Level II Compliance (“that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”)
    • January 1, 2012: All covered entities have to be fully compliant.