The October 1, 2015 deadline for the mandatory use of ICD-10 codes is approaching quickly. In preparation for this transition, Health Data Services has put together a robust toolset designed to help your practice prepare and become familiar with the new code set. Your practice will be able to greatly reduce issues and problems by beginning to incorporate ICD-10 codes now. Throughout this document, any and all references to ICD-10 is only meant to include
The use of ICD-9 codes vs. ICD-10 codes is based on the date of service. If the service date is September 30, 2015 or before then you MUST use ICD-9 codes for encounters and claims.For any date of service October 1, 2015 or later, you MUST use ICD-10 codes. Multi-date encounters may not span across September 30th and October 1st. In these cases you must create separate encounters, one encounter for services up to and including September 30th, 2015 (using ICD-9), and a second encounter for services beginning October 1st, 2015 (using ICD-10). All claims for service dates prior to October 1st will use ICD-9, regardless of when the claim is filed. Resubmissions and secondary claims for service dates prior to October 1st will still use ICD-9, even if they are filed on or after October 1st.
While you cannot start using ICD-10 codes on your encounters or claims until October 1st, you can (and should) begin working with ICD-10 codes now. This release contains new functionality and tools that allow you to be fully prepared for the October 1st deadline. With this release, you can explore the ICD-10 code set and familiarize yourself with its use and structure. You can use the Mapping tool to determine how the ICD-9 codes you currently use relate to the new ICD-10 codes. You can begin creating your ICD-10 diagnosis codes for frequently used diagnoses. You can also create “cross-reference” ICD-10 codes for Problem Type and Problem records to facilitate coding encounters when ICD-10 use begins. By cross-referencing your existing Problem Type and Problem records you can greatly reduce the amount of time spent determining which ICD-10 codes you should use.
As you are probably aware, the ICD-10 code set is much larger than the ICD-9 code set. ICD-10 contains about 68,000 codes while ICD-9 contains about 13,000 codes. This large increase in the number of codes can seem intimidating, and while there are a lot of new codes, many of them are simply variants of an old existing diagnosis (but with a new code). For example, a single ICD-9 code may now be three ICD-10 codes, but the three new codes are all for the same diagnosis with the only difference being “initial”, “subsequent”, or “sequela”. In other cases, a single ICD-9 which represented several combined problems is now represented by several individual ICD-10 codes. ICD-10 is a more logical representation than ICD-9 and you will get the hang of it once you start using it. The codes themselves are different, so you will need to know, or be able to determine, the new codes.
The Mapping function of the ICD-10 Browser makes it much easier to determine what ICD-10 code or codes you should use. The ICD-9 to ICD-10 Mapper utilizes the GEM (General Equivalence Mappings) created and released by CMS. The GEM does a great job of mapping from one code set to the other, but there are some very important caveats. ICD-10 is not ICD-9 with more codes; ICD-10 is a much more detailed and refined code set. There are many ICD-9 codes that map to an approximate ICD-10 code. These codes are just that – approximate. Sometimes the approximate code may be the correct code. At other times, the approximate code will get you close to what you need but you will have to explore similarly related codes to see if there is one that is more accurate and/or more specific for your use. Again, the Mapping function of the ICD-10 Browser is extremely helpful both in performing the mapping as well as in positioning you in the code list so you can examine similar codes.
Please continue through all of the following pages to fully familiarize yourself with the ICD-10 Browser and associated code set.
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