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ICD-10: Answers to Frequently Asked Questions

As practices begin working on the transition to ICD-10, more and more questions are emerging every day. Here’s a look at four Frequently Asked Questions (FAQs), with answers to help you prepare:

FAQ: What is the difference between ICD-10-PCS codes and ICD-10-CM codes?

ICD-10-CM codes are diagnosis codes. They are defined globally by the World Health Organization (WHO), but are modified for use in the United States by the National Center for Health Statistics (NCHS). Most professional, outpatient and ambulatory practices will use ICD-10-CM codes.

By contrast, ICD-10-PCS codes are procedure codes. These codes are created by the Centers for Medicare and Medicaid Services (CMS) and are only used on inpatient, facility-based claims. Ambulatory practices will continue to use CPT procedure codes, just as they do now, when ICD-10 takes effect.

FAQ: Are the ICD-10 codes already determined or will they change before October 1, 2013?

The ICD-10 codes have been defined since 1994, but updates can be expected before the compliance date. These updates will not represent major changes to ICD-10 format, structure or documentation. Instead, they will include minor revisions to further define the code set. Current information on the ICD-10 code sets can be found at www.icd10hub.com.

FAQ: If I submit a claim with ICD-9 codes before the compliance date and it denies or rejects, would I submit the corrected claim with ICD-10 codes after the compliance date?

The date of service (for professional claims) or the date of discharge (for inpatient claims) determines when you will use ICD-9 or ICD-10 codes. The date of claim submission doesn’t matter. You must use ICD-9 codes on claims for dates of service prior to the compliance date—even if you submit the claim after the October deadline.

FAQ: I’m a certified coder. Will I have to pass an ICD-10 test to keep my certification?

Even if you currently are a certified ICD-9 coder, most certifying organizations will require a test to recertify for ICD-10.