- Regardless of when the claim is submitted, ICD-10 codes are only to be used for service(s) provided on or after October 1, 2014.
- The code set has been expanded from five to seven positions. The codes use alphanumeric characters in all positions, not just the first position.
- The new code set increases the specifics of the reporting, allowing for more information to be communicated within the code. It also allows for future expansion and definitions.
- Most of the new concepts in ICD-10 coding are concepts that any physician is already documenting now. They understand the significance in understanding severity, risk and a variety of other important parameters related to proper health assessment and treatment.
- There are codes that are a combination of diagnoses and symptoms, so fewer codes may be needed to report or describe a condition.
- ICD-10 codes enable lateral reporting (right vs. left) reflecting which side of the body or limb is subject to evaluation. About 25,000 (36%) of the new codes are different only because they distinguish “right” vs. “left.” You can also report location such as medial, distal or proximal.
- Requirements are different for all specialties. For example, Ophthalmology codes have changed very little in scope, but codes for musculoskeletal systems have increased dramatically… over 50% of the ICD-10 codes are related to musculoskeletal conditions. Over 17,000 ICD-10 codes (about 25%) are related to fractures.
- There are some one-to-one mappings, but often there are one-to-many, many to one, many-to-many, or none at all. There is no clear mapping between ICD-9 and ICD-10.
- Transition to ICD-10 does not directly affect provider use of CPT or HCPCS codes.
Step 2a - To Sync the codes (automatically):
Step 2b - To Map the codes (manually):
- The Practice Default is activated/selected (Step 1), and…
- The ICD-10 code exists and synced to the ICD-9 already on the claim (Step 2), and…
- The carrier is set up for ICD-10 submission (Step 3), and…
- The claim’s service date is after the ICD-10 Start Date (Step 4).
The clearinghouse will respond with a “999” confirmation that the file is acceptable but will not forward the claims to the payers for further adjudication or testing. An acceptable response confirms your ability to submit ICD-10 coded claims to the clearinghouse.