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ICD-10 Quick Start Guide

Brooke Phillips, CWCMS
Editor | Shield HealthCare
12/01/15  5:21 PM PST
ICD-10 Quick Start Guide

This guide from the Centers for Medicare and Medicaid Services outlines 5 steps health care professionals can take to prepare for ICD-10 compliance. You can complete parts of different steps at the same time if that works best for your practice. Click here to download the original ICD-10 Quick Start Guide from CMS.

You must use:

  1. ICD-10 codes for all services provided on or after October 1, 2015
  2. ICD-9 codes for all services provided before October 1, 2015

! = Crucial activity


  1. Make a Plan

Assign target dates for completing steps outlined here.

! Obtain access to ICD-10 codes. The codes are available from many sources and in many formats:

  • Code books
  • CD/DVD and other digital media
  • Online (e.g., go to cms.gov/ICD10 and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
  • Practice management systems
  • Electronic health record (EHR) products
  • Smartphone apps

Decide role(s) your clearinghouse(s) 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 claims being 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.

  1. 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 (see Specialty References)
  • Medical specialty societies

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

  1. 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
  1. 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.

  1. 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

Ask other health plans you work with about the options they offer.

To learn more about getting ready from the Centers for Medicare & Medicaid Services, visit cms.gov/ICD10 for free resources, including the Road to 10 tool.  The Road to 10 was designed especially for small and rural practices but may be useful for all health care professionals.

For more information about the transition to ICD-10, visit shieldhealthcare.com/healthcarenews.

Resources: https://www.cms.gov/medicare/coding/icd10/downloads/icd10quickstartguide20150622.pdf

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