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ICD-10
While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors did not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.
Beginning on October 1, 2016, the one-year contingency period during which clinicians were not penalized for billing non-specific codes (when a more specific code is available) will end. Claims must now include ICD-10-CM codes to the highest level of specificity possible based on documentation.
ICD-10 in Your Practice
Tools and resources to help implement ICD-10-CM in practice.
- ICD10 Next Steps: This assessment and maintenance toolkit from CMS can help practices identify opportunities for improvement in using ICD10.
- ICD-10 Questions or Problems
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- ICD-10 FAQs
- Provider ICD-10 Resource Guide and Contact List
- Medicare MAC Directory: Your MAC is your first line for Medicare claims questions related to ICD10.
- Medicaid ICD-10 Information
- ICD-10 Ombudsman
- Commonly Used ICD-10-CM Codes: This list of commonly used diagnoses can be printed out and used in your practice. Laminated versions are available at Internal Medicine and chapter meetings.
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- ICD-10 Code Lookup
- TurboCoder: Digital books, discounted for ACP members.
- Issues related to National and Local Coverage Determinations
- ICD-10 Clinical Concepts for Internal Medicine - This document highlights ICD-10 concepts for conditions like asthma, diabetes, hypertension, and acute myocardial infarction, including codes, documentation tips and clinical scenarios to help with the transition to ICD-10.
- The Role of Clearinghouses in the ICD-10 Transition
- ICD-10 2015 General Equivalence Mappings (GEMs)
- 2016 ICD-10-CM GEMs
- Sample Super Bill 1
- AHA Coding Advisor - The AHA offers free coding advice regarding ICD-10-CM, ICD-10-PCS, and HCPCS (registration required, but it is open to non-AHA members).
- Split Billing - How to bill for services that span October 1.
- State Medicaid Readiness
- Worker's Comp Readiness
- ICD10 Tips
ICD-10-CM Training
Where to find high-quality, low or no-cost training for clinicians and staff.
- Post-Implementation: Coding Basics Revisited - This video explains what is a valid code, guidelines for reporting, and more. (33 minutes)
- ICD-10 Coding Basics - This free video from CMS provides a basic introduction to ICD-10 coding, including comparing ICD10 to ICD9, structure, how to use the new system, and examples. (26 minutes).
- Documentation Concepts for IM/FP - This free video provides training focused on unique aspects of ICD-10 for internal medicine and family practice. Examples include the documentation requirements for several common conditions, documentation changes and new concepts, and the use of "unspecified" codes in ICD-10 (45 minutes)
- CMS Videos - These short videos explain key ICD10 concepts
- CMS Podcasts - CMS participates in the ICD-10 Monitor's Talk Ten Tuesday podcasts
- Road to 10: A free one-stop source for all things ICD-10 from CMS.
There are many organizations that offer training in a wide variety of formats for a wide variety of prices. The following organizations offer high quality training for reasonable prices.
ICD-10 Resources by Source
The following entities provide excellent ICD-10-CM and PCS coding resources, some of which is included above, for all types of organizations and all types of personnel, much of which is available for free and some for a fee.
- CMS ICD-10 Resources
- AHA Coding Advisor - The AHA offers free coding advice regarding ICD-10-CM, ICD-10-PCS, and HCPCS (registration required, but it is open to non-AHA members).
- American Academy of Professional Coders (AAPC) - Training resources for physicians and office staff from the American Association of Professional Coders. (Live and on-line training available for a fee as well as coding assessments.)
- American Health Information Management Association (AHIMA) - The American Health Information Management Association offers training and implementation resources in both ICD-10-CM and PCS.
- AMA's ICD-10 Resources
- PhysiciansPractice - This commercial site has a wide variety of articles from their journal as well as videos and other resources (free registration required).
- WEDI - WEDI has state readiness lists, including Medicaid and worker's comp, as well as an implementation tool kit
Understanding ICD-10
Resources for the what, why, and how of using ICD-10 code sets.
- Frequently Asked Questions:
- ICD-10 Key Target Dates, Deadlines, and Resources
- ICD-10 Myths and Facts
- ICD-10-CM Primer
- ICD11