Ameritox

ICD-10 Compliance

On October 1, 2015, the U.S. will transition from ICD-9 to ICD-10 as the medical code set for medical diagnoses and inpatient hospital procedures. Health care providers using ICD-9 codes on or after October 1, 2015 will be unable to bill for their services.

ICD-10 consists of two parts:

  • ICD-10-CM diagnosis coding for use in all U.S. health care settings.
  • ICD-10-PCS inpatient procedure coding for use in U.S. hospital settings.

The federal mandate to transition to ICD-10 pertains to all HIPAA-covered entities including Providers, Payers, Vendors and their business associates:

  • Claims for dates of service on or after the compliance date must be submitted with ICD-10 diagnosis codes.
  • Claims for dates of service prior to the compliance date must be submitted with ICD-9 diagnosis codes.

FAQs

WHEN is the compliance deadline for ICD-10?

On July 31st, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the compliance date for health care providers, health plans, and health care clearinghouses to use ICD-10, the tenth revision of the International Classification of Diseases. This deadline was intended to allow time for providers, insurance companies and others in the health care industry to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

WHO does ICD-10 compliance affect?

The federal mandate to transition to ICD-10 pertains to all HIPAA-covered entities including Providers, Payers, Vendors and their business associates. For guidelines on what qualifies as a HIPAA-covered entity, please visit http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html.

WHAT does ICD-10 compliance mean?

ICD-10 compliance means that HIPAA-covered entities must utilize ICD-10 codes for healthcare services delivered on or after Oct 1, 2015. Beginning October 1, 2015, Ameritox will be unable submit claims using requisitions containing ICD-9 codes. Ameritox will contact the customer submitting such a requisition in an effort to obtain an ICD-10 code, which may delay filing of these claims.

What are some of the differences and improvements of the ICD-10 classification system?

Diagnosis coding under the ICD-10-CM (Clinical Modification) system uses 3-7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM.

Diagnosis coding under the ICD-10-PCS (Procedure Coding System) uses 7 alpha or numeric digits while the ICD-9-CM coding system uses 3 or 4 numeric digits.

The new classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical medicine.

WHERE can I find a list of ICD-10 codes?

The ICD-10-CM and ICD-10-PCS code sets, as well as the official ICD-10-CM guidelines, are available free of charge on the:

Additionally, we recommend that customers contact their payers and trading partners in advance of the October 1 deadline to request a copy of the crosswalk mapping tool these entities are utilizing.

HOW do providers prepare for the transition to ICD-10?

CMS offers free help, including tools to jumpstart your efforts. A good place to start is with the new ICD-10 Quick Start Guide at: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf

HOW has Ameritox prepared for ICD-10?

Ameritox will update its online and paper requisitions to enable the selection of ICD-10 codes that are commonly used to support medical necessity in urine drug monitoring. As a reminder, it is the physician’s responsibility to use his or her professional medical judgment to indicate the most appropriate diagnosis code(s) for each patient encounter. A comprehensive listing of commonly used ICD-10 codes in UDM may also be found at www.ameritox.com/codes and www.ingenuityhealth.com/codes.