ICD-10 Overview and FAQ

What is ICD-10?

ICD-10 stands for International Classification of Disease, Tenth Edition.  It is a revision of the system providers currently use to code all diagnoses, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases recorded in hospitals and physician practices.  ICD-10 compliance is mandatory for all HIPAA-covered entities.

Who does ICD-10 affect?

ICD-10 compliance is mandatory for all HIPAA-covered entities, including those who do not handle Medicare claims. There are no exceptions to any HIPAA-covered entities. Organizations that are not governed by HIPAA who use ICD-9 codes should be aware that their coding may become obsolete in the transition to ICD-10. Providers who have not switched to ICD-10 will experience delayed payments or even non-payment and a possible increase in rejected, denied or pending claims. Payments to providers cannot be made without the proper ICD-10 coding.

When does ICD-10 go into effect?

ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service and inpatient claims with dates of discharge on and after October 1, 2015.

When do I need to start using ICD-10 codes on my claims?

ICD-10 goes into effect October 1, 2015. Your practice must start using ICD-10 codes for services provided on or after October 1, 2015. Billing for professional and outpatient services is based on the date of service while inpatient billing is based on the date of discharge.

Can I start using ICD-10 codes prior to October 1, 2015?

No. ICD-10 coding is based on the date of service. ICD-9 codes must be up to and including September 30, 2015. ICD-10 codes must be used for services performed on or after October 1, 2015.

Can I use both ICD-9 and ICD-10 codes on my claim?

No. All claims must contain only one code set.

How long will ICD-9 codes be accepted?

bFlow will continue to allow ICD-9 codes to be processed through to payers after the deadline. It is up to the payer whether they will accept ICD-9 codes past the October 1, 2015 deadline or not. Some payer types are not mandated to adopt ICD-10 and may choose to continue processing claims using ICD-9 codes. Workers’ Compensation and Auto Insurance Payers are examples of Non-covered entities that are not mandated to adopt ICD-10 codes.

What constitutes a valid ICD-10 code?

ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. To be valid, a code must be coded to the full number of characters required for that code, including the 7th character, if applicable. Many people use the term billable codes to mean valid codes. A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website. The codes are listed in tabular order (the order found in the ICD-10-CM code book).

How does ICD-9 compare to ICD-10?

Below is a brief comparison of the ICD-9-CM and ICD-10-CM diagnosis codes.

Has bFlow tested with all payers?

bFlow has been actively testing our Payer connections. We have tested extensively and are ready for the October 1, 2015 deadline.

Which payers are ready for ICD-10? Which payers are not?

bFlow transmits your claims to InstaMed which operates as a clearinghouse and has been sending payers 5010 transactions that natively support ICD-10 codes since 2011. As a clearinghouse, InstaMed is responsible for delivering claims to payers for adjudication. It is up to the specific destination payer to be ready to receive ICD-10 coded claims. For specific information regarding payer readiness, please contact the payer directly. If InstaMed is notified of payers who will not be ready by the deadline we will post this information to our website.

For more details, visit the following resources:

• CMS
• MCS ICD-10-CM Classification Enhancements
• AMA
• AMA ICD-10 Fact Sheet 1
• AMA ICD-10 Fact Sheet 2

For additional information please contact [email protected]