ICD-10 What you need to know

By: Nick Austin

On October 1st, 2015, ICD-10 will be implemented unless there is another congressional delay. All signs are pointing to implementation, so like it or not, ICD-10 will most likely happen in 2015. TheraOffice will be ready with plenty of time for testing before the October deadline.

The US healthcare system currently utilizes the International Classification of Disease Revision 9, while the World Health Organization (WHO) has been using ICD-10 since 1994. ICD-11 is also in development and there are some that suggest the WHO will adopt it as early as 2015.   There have been arguments about holding off on ICD-10 and moving directly into ICD-11, however, the transition to ICD-11 is thought to be easier when moving from ICD-10, so a sequential adoption would probably yield the best results.

ICD-10 has two sets of codes, diagnosis codes (ICD-10-CM) and inpatient procedure codes (ICD-10-PCS). As PTs bill using outpatient procedure codes, all references to ICD-10 are in reference to diagnosis codes. All HIPAA covered entities will require ICD-10, so this extends beyond Medicare and Medicaid programs, but does not include Worker’s Compensation. As of October 1st, 2015, all visits for covered entities will require ICD-10 diagnosis codes. Visits before the transition date should still be using ICD-9 codes.

The biggest change from ICD-9 to ICD-10 is the format of the code. ICD-10 codes can have between 3 and 7 characters. The first 3 codes are the category codes, which can be sub divided by the use of the 4th, 5th, or 6th code. Lucky for us very few codes have only 3 characters, so we will need to become familiar with the subdivided characters.   Characters 4-7 will provide greater detail about the etiology, anatomical site, and severity. The last character (7th) will be used to provide data about the characteristics of the encounter.

Another unique feature of the ICD-10 coding format is the use of “x” as a placeholder, so a code may look like the following: T45.0x1A. You notice there are seven characters, but the “x” is only used as a placeholder. The bottom line is ICD-10 will create codes which are more specific to the patient’s condition, making it imperative all clinical documentation is thorough and complete.

A feature of ICD-10 which has been causing some waves is the list of External Cause Codes. This is a subset of codes which are used to better describe the actual diagnosis code, referred to as Principle Codes. Think of External Cause Codes as adjectives used to describe the noun. Without the noun, the adjective is meaningless.   With an increased stress on specificity, we might see a more wide-spread use of these codes with ICD-10 compared to their current use in ICD-9.

So the next step is understanding the process. On Thursday, October 1, 2015 all claims covered under HIPAA must be submitted with correct ICD -10 formatted codes. The day before (Wednesday) claims must be submitted with ICD-9 codes, therefore it is important to have a plan for the clinic.


1. Identify someone at your facility to be the ICD-10 Expert.

Having one person taking the lead will help the overall organization and implementation of the ICD-10 codes. This person   should have a basic understanding of clinical documentation and medical coding/billing. Having a lead will also help make sure the whole staff is on the same page.

2. Have a Documented Plan for your Business

There are many resources available for your staff online. Center for Medicare and Medicaid Services (www.cms.gov) has checklists and planning tools available, just search for ICD-10 on their website.   The Center for Disease Control and Prevention also has tools online (www.cdc.gov) to help with the transition. There is an ICD-10 document on the CDC website which will give a complete overview of the ICD-10 program.

3. Talk with your Software Vendors and Clearinghouse, they most likely have educational information or even webinars to discuss ICD-10 transition.

At Hands on Technology we are getting ready to launch our ICD-10 Webinars to review our timeline for ICD-10 implementation and what is going on behind the scenes to make the transition as easy as possible for our end users. ICD-10 impacts all parts of the typical Practice Management and EMR Solutions on the market, and vendors need time to develop, test, and release software. Transparent Communication is important.

4. Engage Staff

ICD-10 will put emphasis on clinical documentation. It may not happen all at once, but ICD-10 coding is designed to better describe the patient condition with greater detail. It will not surprise any provider if payers eventually use this as their main tool to deny care for lack of clinical documentation. So use the time up to implementation to educate staff about defensible documentation principals.

5. Don’t wait until it’s too late.

There are good indications ICD-10 will happen this year, therefore, it is important to be prepared. Poor ICD-10 planning and implementation could disrupt cash flow and increase AR drastically if you are not fully prepared by October 1st, 2015


All signs point to ICD-10 being implemented in 2015, so a little planning will make this an easier transition for your facility. It is also a time to have your clinicians brush up on their documentation skills, because ICD-10 will demand increased details of the patient’s condition. At Hands on Technology we are hoping ICD-10 creates a renaissance in which documentation is controlled by the healthcare providers and not the 3rd party payers.   We look at ICD-10 and we see opportunity, we hope you will also.