Since October of 2015, ICD-9 is no longer being used to submit medical claims. Instead, ICD-10 codes have been implemented as a way to modernize communication between physicians, pharmacies, and insurance providers. More information is presented below regarding the updated system of codes that includes over 69,000 entries.

Why Is ICD-10 Necessary?

The U.S. Department of Health and Human Services implemented the change as part of the HIPAA regulations in order to provide a more vibrant code structure for the national health care system. The old system, ICD-9, had limited capabilities due to the fact that its structure limited the number of categories that could be utilized and most of these were completely filled up. Moreover, the codes weren’t consistent with current practices due to their limited use with existing medical procedures and prescriptions.

What Does ICD-10 Mean?

ICD-10 codes provide enhanced accuracy and ease of communicating important details regarding a patient’s diagnosis and treatment. The ICD-10 system provides diagnosis and procedural codes for use within the health care industry.

What Does ICD-10 Compliance Mean?

All HIPAA-labeled organizations are required to use the existing listing of ICD-10 codes until future revisions are made. Compliance is not optional. The codes must be used for all inpatient procedures and services. Compliance ensures greater accuracy in health care transactions for all involved entities.

Non-compliance with ICD-10 code implementation can lead to one or more of the following problems:

  • Delay in receiving payment
  • Failure to receive payment
  • Claim rejection
  • Pending claim status
  • Denied claim status
  • Lost revenue due to problems processing claims

No claims will be processed if they include only ICD-9 codes. Moreover, any claim that includes a mix of ICD-9 and ICD-10 codes will receive a pending, denied, or rejected status upon review.

Isn’t the ICD-10 Transition Intended for Medicaid and Medicare?

No. The ICD-10 transition and compliance mandate isn’t designed just for Medicaid and Medicare claims. All HIPAA-covered entities must use the new listing of diagnostic codes.

What Type of Claims Are Required to Use ICD-10 Codes?

All medical claims are required to use the ICD-10 codes. This policy includes electronic and paper claims.

How Is ICD-10 Different from ICD-9?

The transition from ICD-9 to ICD-10 implemented two important changes to this system of codes. In an effort to deliver better identification, the ICD-10 codes offer a higher standard for descriptive purposes. Additionally, the new codes incorporate letters of the alphabet with numbers. The ICD-9 codes had three, four, or five numbers for the most part, while the ICD-10 codes have three to seven numeric/alphanumeric characters.

Does the New ICD-10 List Affect the System for Outpatient Procedures?

No. For outpatient procedures, the existing CPT (Current Procedural Terminology) coding system remains in place.

How Are TARs Affected by the New Coding System?

TARs (Treatment Authorization Requests) must include an ICD-10 code for all diagnoses.