Official CMS Industry Resources for the ICD-10 Transition
[Link]/ICD10
ICD-10 Basics for Background
Medical Practices
Begin preparing now for the ICD-10 transition to make sure you are ready The ICD-10 transition is coming on October 1,
by the October 1, 2013, compliance deadline. The following quick checklist 2013. A related change, the transition to Version
5010 standards for electronic transactions
will assist you with preliminary planning steps.
happens before then, on January 1, 2012.
Everyone covered by HIPAA is affected. Now is
Identify your current systems and work processes that use ICD-9 the time to prepare.
codes. This could include your clinical documentation, encounter
forms/superbills, practice management system, electronic health About ICD-10
record system, contracts, and public health and quality reporting
ICD-10 CM/PCS (International Classification of
protocols. It is likely that wherever ICD-9 codes now appear, ICD-10
Diseases, 10th Edition, Clinical Modification/
codes will take their place. Procedure Coding System) consists of two
parts:
Talk with your practice management system vendor about
accommodations for both Version 5010 and ICD-10 codes. 1. ICD-10-CM for diagnosis coding
Contact your vendor and ask what updates they are planning to your
2. ICD-10-PCS for inpatient procedure coding
practice management system for both Version 5010 and ICD-10, and
when they expect to have it ready to install. Check your contract to ICD-10-CM was developed by the Centers for
see if upgrades are included as part of your agreement. If you are Disease Control and Prevention for use in all
in the process of making a practice management or related system U.S. health care settings. Diagnosis coding
purchase, ask if it is Version 5010 and ICD-10 ready. under ICD-10-CM uses 3 to 7 digits instead of
the 3 to 5 digits used with ICD-9-CM, but the
Discuss implementation plans with all your clearinghouses, format of the code sets is similar.
billing services, and payers to ensure a smooth transition. Be ICD-10-PCS was developed by the Centers for
proactive, don’t wait. Contact organizations you conduct business Medicare & Medicaid Services (CMS) for use
with such as your payers, clearinghouse, or billing service. Ask about in U.S. inpatient hospital settings only. ICD-10-
their plans for the Version 5010 and ICD-10 compliance and when PCS uses 7 alphanumeric digits instead of the
they will be ready to test their systems for both transitions. 3 or 4 numeric digits used under ICD-9-CM
procedure coding. Coding under ICD-10-PCS is
Talk with your payers about how ICD-10 implementation might much more specific and substantially different
from ICD-9-CM procedure coding.
affect your contracts. Because ICD-10 codes are much more specific
than ICD-9 codes, payers may modify terms of contracts, payment The transition to ICD-10-CM/PCS does not
schedules, or reimbursement. affect Current Procedural Terminology (CPT)
codes, which will continue to be used for
Identify potential changes to work flow and business outpatient services.
processes. Consider changes to existing processes including
clinical documentation, encounter forms, and quality and public
health reporting.
Assess staff training needs. Identify the staff in your office who
code, or have a need to know the new codes. There are a wide Visit [Link]/ICD10
variety of training opportunities and materials available through for ICD-10 and Version 5010
professional associations, online courses, webinars, and onsite
resources from CMS.
training. If you have a small practice, think about teaming up with
other local providers. You might be able, for example, to provide
I061 Rheumatic aortic insufficiency
I062 Rheumatic aortic stenosis with insufficiency
I068 Other rheumatic aortic valve diseases
I069 Rheumatic aortic valve disease, unspecified
I070 Rheumatic tricuspid stenosis
I071 Rheumatic tricuspid insufficiency
I072 Rheumatic tricuspid stenosis and insufficiency
I078 Other rheumatic tricuspid valve dis
training for a staff person from one practice, who can in turn train staff members in other practices.
Coding professionals recommend that training take place approximately 6 months prior to the October
1, 2013, compliance date.
Budget for time and costs related to ICD-10 implementation, including expenses for system
changes, resource materials, and training. Assess the costs of any necessary software updates,
reprinting of superbills, training and related expenses.
Conduct test transactions using Version 5010/ICD-10 codes with your payers and clearinghouses.
Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and
subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your
payers and billing service or clearinghouse. Check to see when they will begin testing, and the test days
they have scheduled. If you submit electronic claims, you need to have completed internal testing of
Version 5010 systems in time to begin external testing with your payers, clearinghouses, billing services,
and other business partners by January 1, 2011.
This fact sheet was prepared as a service to the health care industry and is not intended to grant rights or impose obligations. The information
provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage
readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.
APRIL 2010
Official CMS Industry Resources for the ICD-10 Transition
[Link]/ICD10
