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ICD-10 Basics

Effective October 1, 2015, t
he ICD-9 code sets used to report medical diagnoses and inpatient procedures were replaced by ICD-10 code sets. In response to requests from the provider community, including the American Medical Association and Medical Society of DC, The Centers for Medicare & Medicaid Services (CMS) released additional guidance to allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. See the CMS guidance and the joint announcement by CMS and AMA.

ICD-10 consists of two parts:

  1)  ICD-10-CM diagnosis coding which is for use in all US health care settings. ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000.
2) ICD-10-PCS inpatient procedure coding which is for use in US hospital settings. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes. ICD-10-PCS is only used for coding hospital inpatient procedures.
    ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.


In-Person Training Options

MSDC partnered with MedChi Network Services to offer members a range of ICD-10 assessment and training options. These services range from basic assessment and/or coding documentation to comprehensive, customized in-person/on-site training for medical teams.  Contact MSDC for more information.


American Medical Association (AMA) 
   AMA ICD-10 Website: AMA ACD-10 Website

ICD-10 Tools From The Centers for Medicaid & Medicare Services (CMS)
   CMS ICD-10 Website:  http://www.cms.gov/ICD10

   Road to 10: CMS Tool for Small Physician Practices

   Small medical practices may visit Road to 10, an online resource from the Centers for Medicaid and Medicare Services designed to help small medical practices in their ICD­10 transition.  

   List of Valid ICD-10-CM Codes
CMS has posted a complete list of the 2016 ICD-10-CM valid codes and code titles, to help physician offices make sure that they are reporting all characters required for a valid ICD-10-CM code.

   Medicare FFS Provider Community 
   Links for Medicare Fee-For-Service (FFS) providers to information and educational resources to implement and transition to ICD-10 medical coding.

ICD-10 Charts  
  ICD-10 Charts was developed by a medical student as a collection of free, innovative ICD-10 training resources to help streamline the entire ICD-10 implementation process and save practices time and money during this transition.  Watch a short informational video to see how the site works.

How to Report Problems
If physicians experience any problems with the processing of their claims or other administrative transactions, they may take the following steps.
• Medicare: The AMA has created an ICD-10 complaint form to report problems with Medicare claims. Physicians can also contact their Medicare Administrative Contractor (MAC) or monitor their MAC’s website for information on problems with ICD-10. The MAC for Washington, DC and Maryland is Novitas Solutions and it has an ICD-10 webpage with additional information.
Physicians may contact CMS directly by emailing the ICD-10 ombudsman Dr. William Rodgers, whose contact email is ICD10_Ombudsman@cms.hhs.gov. Laura DeVirgilio and Mike Massimini will be the Region 3 (Washington, DC Area) points of contact for ICD-10 related inquiries. If physicians have questions or concerns regarding ICD-10, please send them to the following email address: ROPHICFM@cms.hhs.gov.
• Medicaid: The DC Medicaid Program has confirmed by email to the Medical Society of DC that it will accept "a valid ICD-10 code regardless of the level of specificity."
• Commercial Payers: Check the payer’s website for information about ICD-10 implementation and a method of contact for issues.
o For UnitedHealth Group, physicians can use the following email address ICD10questions@uhc.com
o For CareFirst, physicians can check the website: https://provider.carefirst.com/providers/resources/icd-10.page?
o For Humana, physicians can use the following email address ICD10Inquiries@humana.com


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