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ICD-9 to ICD-10 Transition: What You Need To Know

Brooke Phillips, CWCMS
Editor | Shield HealthCare
09/01/15  10:05 AM PST
ICD-9 to ICD-10 Transition

 ICD-9 to ICD-10 Transition Changes

As of October 1, 2015, CMS is requiring all health care providers to replace ICD-9 diagnosis codes (5 positions) with ICD-10 codes (7 positions). The difference in the format between the coding systems requires major changes for the health care industry. Health care professionals are learning the new coding system and computer systems have been updated to accommodate the changes. The number of diagnosis codes has gone from roughly 14K (ICD-9) to 69K (ICD-10). The additional codes will allow more specificity in diagnosing the condition of the individual (i.e. ICD-9 – arm amputated is the only code, vs ICD-10 – there is a code for both right and left arm amputated).

All providers are required to begin using ICD-10 codes on documentation and claims on October 1, 2015. As of  October 1, 2015, Shield HealthCare systems have ICD-10 codes in all areas previously displaying ICD-9 and on all documents and claims.

The following changes have been implemented:

  • All customer accounts have been transitioned from ICD-9 diagnosis codes to ICD-10 diagnosis codes
  • Documents processed on or prior to September 30, 2015 contain ICD-9 codes and will be valid for requesting authorization and billing after October 1, 2015
  • Documents processed on or after October 1, 2015 contain ICD-10 codes

NOTE: Reprinted and resubmitted documents will have the ICD codes from the original process date (this means a documented reprinted on October 15 that was originally processed on September 15 will have ICD-9 codes).

For more information about the change from ICD-9 to ICD-10, visit www.cms.gov/Medicare/Coding/ICD10/index.html.

Click here for 100 Common Diagnosis Codes: Your ICD-9 to ICD-10 Conversion Guide.

Click here for ICD-10 Frequently Asked Questions.

NEW! Click here to use the ICD-10 code lookup tool on CMS.gov.

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