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ICD-10

ICD-9, which is over 30 years old, is currently used for reporting health care diagnosis codes in the United States. ICD-10-CM is the diagnosis classification system developed by the Centers for Disease Control and Prevention and is currently used in many countries. Diagnosis coding under this system uses a different number of digits and some other changes, but the format is very similar to ICD-9-CM.

ICD-10 Compliance Date

The U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015, as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015.

The rule This link will take you to an external website. requires the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

Stay up to date on ICD-10!

Sign up for CMS ICD-10 Industry Email Updates This link will take you to an external website.

ICD-9 vs. ICD-10 Billing Guidelines Effective October 1

ICD-9 codes will no longer be accepted on claims (including electronic and paper) with from dates of service on or after October 1, 2015.

  • DME claims containing ICD-9 codes for dates of services on or after October 1, 2015, will be returned as unprocessable. Resubmitting these claims with the appropriate ICD-10 code is required.
  • A claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will reject or deny all claims that are billed with both ICD-9 and ICD-10 diagnosis codes on the same claim.
  • For claims with "from" dates of service prior to October 1, 2015, submit with the appropriate ICD-9 codes.
  • For claims with "from" dates of service after October 1, 2015, submit with the appropriate ICD-10 codes.

The CMS Medicare Learning Network (MLN) Special Edition (SE)1408 - Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492 This link will take you to an external website. provides additional guidance on billing claims after the ICD-10 implementation.

Resources

Testing Results

Last Updated Aug 05, 2016

ARTICLES

Coding Revisions to NCDs CR9540   May 12, 2016
ICD-10 is One Week Out  Sep 24, 2015
ICD-10 Testing Approach - Revised SE1409   Dec 11, 2014
ICD-10 Testing Approach - Revised SE1409   Aug 04, 2014
Display of ICD-10 LCDs on the MCD CR8348   Sep 12, 2013