ICD-10 FAQs

Q: When do we need to be compliant with ICD-10?

A:

Oct. 1, 2015

Q: Will ICD-10 replace the current CPT coding?

A:

No. The transition to ICD-10 will not affect your CPT codes for outpatient procedures or physician services. ICD-10-PCS codes are for hospital inpatient procedures only.

Q: Do state Medicaid programs need to transition to ICD-10?

A:

Yes they do. State Medicaid programs must use ICD-10 for services provided on or after Oct. 1, 2015.

Q: What happens if my organization does not switch to ICD-10?

A:

Your claims for all health care services and hospital inpatient procedures performed on or after Oct. 1, 2015, must use the ICD-10 diagnosis and inpatient procedure codes. Claims without ICD-10 codes cannot be processed. Note: Claims for services provided before Oct. 1, 2015, must use ICD-9 codes.

Q: Do we need to use both ICD-9 and ICD-10 codes during the transition?

A:

Practice management systems must be able to accommodate ICD-9 and ICD-10 codes until all claims and other transactions for services before Oct. 1, 2015, have been processed and completed. You should promptly process ICD-9 transactions as the transition date nears to help limit disruptions and limit the time you will need to use dual codes.

Q: Can I start using ICD-10 codes early?

A:

No. Payers will not be able to process claims using ICD-10 codes until Oct. 1, 2015. However, organizations do need to test their software from beginning to end prior to the Oct. 1 date. This involves testing claims, eligibility verification, quality reporting and other transactions and processes using ICD-10 to make sure the new code set can be processed correctly.

Q: Codes change every year…why is this one important?

A:

ICD-10 codes are completely different from ICD-9 codes. ICD-9 codes are currently numeric and have 3 – 5 digits. ICD-10 codes are alphanumeric and contain 3 – 7 characters. ICD-10 is more robust and descriptive, unlike ICD-9 with it´s ‘one too many’ matches.

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