ICD-10 Code
International Classification of Diseases, 10th Revision
Jan 20, 2017

ICD 10 Quick Start Guide

This guide outlines 5 steps health care professionals should take to prepare for ICD-10 by the October 1, 2015, compliance date. You can complete parts of different steps at the same time if that works best for your practice.

You must use:
  • ICD-10 codes for all services provided on or after Oct 1, 2015
  • ICD-9 codes for all services provided before Oct 1, 2015

  • 1: Make a Plan

    Obtain access to ICD-10 codes. The codes are available at ICD10coded.com, as well as from many other sources and in many formats, such as code books, CD/DVD and other digital media, practice management systems, electronic health record (EHR) products and mobile apps.

    Decide roles your clearinghouses will play in your transition. Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims.

    Clearinghouses can help by

    • Identifying problems that lead to claimsbeing rejected
    • Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)

    Clearinghouses cannot help you code in ICD-10 unless they offer third-party billing / coding services.

  • 2: Train Your Staff

    Train staff on ICD-10 fundamentals using the wealth of free resources from CMS, which include the ICD-10 website, Road to 10, email updates, national provider calls and webinars. Free resources are also available from medical societies, health care professional associations, hospitals, health systems, health plans, vendors.

    Identify top codes. What ICD-9 diagnosis codes does your practice see most often? Target the top 25 to start. You might want to look at common diagnosis codes available from Road to 10 or medical specialty societies.

    Using the documentation available, code current cases in ICD-10. Flag any cases where moredocumentation is needed.

  • 3: Update Your Processes

    Update hard-copy and electronic forms (e.g., superbills, CMS 1500 forms)

    • Resolve any documentation gaps identified while coding top diagnoses in ICD-10
    • Make sure clinical documentation captures key new coding concepts
      • Laterality—or left versus right
      • Initial or subsequent encounter for injuries
      • Trimester of pregnancy
      • Details about diabetes and related complications
      • Types of fractures

  • 4: Talk to Your Vendors and Health Plans

    Call your vendors to confirm the ICD-10 readiness of your practice's systems

    • Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
    • Ask vendors, health plans, clearinghouses, and third-party billers about testing opportunities

  • 5: Test Your Systems and Processes

    Verify that you can use your ICD-10-ready systems to:

    • Generate a claim
    • Perform eligibility and benefits verification
    • Schedule an office visit
    • Schedule an outpatient procedure
    • Prepare to submit quality data
    • Update a patient’s history and problems
    • Code a patient encounter

    Test your systems with partners like vendors, clearinghouses, billing services, and health plans; focus on those partners that you work with most often.

    Medicare providers can conduct acknowledgement testing with their Medicare Administrative Contractors (MACs) until the Oct 1 compliance date to confirm that Medicare can accept your ICD-10 claims.

    Explore alternate ways to submit claims to health plans if you think your systems might not be ready for ICD-10 by Oct 1.

    For Medicare providers, options include:

    • Free billing software available from every MAC website
    • Part B claims submission by online provider portal (in about ½ of MAC jurisdictions)
    • Paper claims for providers who meet Administrative Simplification Compliance Act Waiver requirements

    Each of these options requires you to code in ICD-10

To learn more about getting ready, visit cms.gov for free resources including the Road to 10 tool designed especially for small and rural practices but useful for all health care professionals.

When ICD 10 was implemented on October 1, 2015, it did not affect physicians', outpatient facilities', and hospital outpatient departments' use of CPT codes on Medicare Fee-For-Service claims. Providers should continue to use CPT codes to report these services.