The new International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes are set to replace the current ICD, Ninth Revision (ICD-9) codes October 1, 2015. The ICD-9 code set is more than 30 years old and is no longer considered usable for modern treatment, reporting, and payment processes. The ICD-10 is believed to better reflect advances in medical technology and knowledge, and has an expanded code format so as to include greater detail.

On its website, The American Medical Association points out, "Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments."

In terms of helping medical staff ease into the new coding requirements, physicians will be relieved to learn that they are being given some breathing room. The Centers for Medicare and Medicaid Services (CMS) has announced it will be relatively flexible about accepting claims.

In a joint announcement, the AMA and CMS state that additional guidance will be released "that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD-10 code set."

The CMS say that for 12 months after ICD-10 implementation, "Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule ... based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family." In addition, a year-long grace period will also apply to codes submitted in connection with the Meaningful Use program, and quality reporting programs such as the Physician Quality Reporting System.

Furthermore, the CMS has announced it will establish an ombudsman in a new ICD-10 communications and coordination center. Its role will be to "…triage and answer questions about the submission of claims." This new communications and coordination center will "…[learn] from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition," say the CMS.

Lastly, the CMS has agreed to authorize advance payments to physicians in some cases where there are problems submitting ICD-10 codes. Nevertheless, "…the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes," states the joint AMA and CMS announcement.

A useful Claims Processing Guidance document, titled, MLN Matters Article #SE1408 has been published by the CMS. It is a reissue of an earlier version (MM7492), reflecting the October 1, 2015, implementation date. The article includes tables for providers on claims that span the periods where ICD-9 and ICD-10 codes may both be applicable.

The AMA recommends that physicians ensure the necessary software updates are installed for the version 005010 (5010) electronic administrative transactions. "Your conversion to ICD-10 will be heavily dependent on when your vendor has the upgrades completed and when they can be installed in your system," warns the AMA. "Identify staff training needs and complete the necessary training," it adds.


American Medical Association. ICD-10 Code Set to Replace ICD-9.

Department of Health and Human Services Centers for Medicare & Medicaid Services. Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) - A Re-Issue of MM7492

CMS, AMA Unveil Steps to Ease ICD-10 Transition

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