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ICD-10 - Despite the Deadline Extension, It's Still Time to Prepare


The Department of Health and Human Services recently announced its intent to push back the October 1, 2013 ICD-10 compliance deadline for certain health care entities. The new proposed date is October 1, 2014. Based on what the industry has learned from the transition to 5010, we all know that it is never too early to start preparing!

Recently, we presented a webinar with the American Academy of Professional Coders (AAPC) to inform practices on how ICD-10 will impact the way that they do business. When we received nearly 400 questions from attendees at that webinar, we realized that there is still a lot of confusion about what ICD-10 is, why we have to make the switch, and what changes practices will have to adopt internally to be compliant.

Here are answers to the most common questions that we have received:

What is ICD-10? International Classification of Diseases (ICD) codes are alphanumeric designations that providers assign to every medical diagnosis and description of symptoms for patients. ICD-10 is the 10th edition of these codes and will replace the ICD-9 system currently in use in the United States.

Why are we changing to ICD-10? There are multiple reasons for the change to ICD-10. The United States is the only country that currently is still using ICD-9, and the switch to ICD-10 will allow us to compare our healthcare data more accurately with other countries. ICD-10's more expansive system will also help us to track data more effectively in order to measure the quality and safety of care; process claims for reimbursement; and improve clinical, financial, and administrative performance.

When will we begin using ICD-10?
As stated, the proposed compliance deadline is October 1, 2014. There is also the opportunity to send comments to Health and Human Services by May 17, 2012. However, we do know that code set usage will depend on whether you are submitting an inpatient or outpatient claim. If you are billing outpatient claims, you will use ICD-9 for dates of service prior to the compliance deadline and ICD-10 for services after the deadline. For inpatient claims, the code set will be based on the discharge date.

Is the switch to ICD-10 just for Medicare and Medicaid, or are other insurance companies changing, too? HIPAA mandates that all insurance plans in the United States make the transition to ICD-10.


How many codes will there be in ICD-10? ICD-10 will include 140,000 codes, while ICD-9 is made up of only 17,000 codes. The additional codes will allow practices to more precisely report the care they provide to patients on their claims.

Where can I find the new ICD-10 code sets?
The ICD-10-CM and ICD-10-PCS code sets are currently available free of charge and can be found on the CMS website (

If we have the ICD-10 codes, can we start using them now?
ICD-10 code sets cannot be used until the compliance deadline. You will need to continue using ICD-9 until that date.

Why should I start preparing now for the ICD-10 transition?
The transition to ICD-10 is a major undertaking for providers, payers, and vendors. It will drive business and systems changes throughout the healthcare industry, from large national health plans to small provider offices, laboratories, medical testing centers, hospitals, and more. To ensure a smooth transition, these organizations need to devote staff time and financial resources to transition activities. So, it's best to develop a transition plan now and start preparing your staff. A successful transition to ICD-10 will be vital to transforming our nation's healthcare system and ensuring uninterrupted operations.

What type of training will providers and staff need for the ICD-10 transition?
Training needs will vary for different organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding. You and your staff should take advantage of specialty-specific ICD-10 training offered by societies and other professional organizations.

CMS and coding associations, such as AAPC, have resources to help providers prepare for a smooth transition to ICD-10. These organizations will continue to add new tools and information to their sites through the course of the transition, so visit regularly to access the latest information and training opportunities. For a compilation of key industry resources on ICD-10, visit

Shelly Guffey, Manager, Premier Accounts and Vendor Partners at Gateway EDI, helps physicians optimize revenue by managing relationships with large medical practices and vendor partners. With more than 20 years experience in medical billing services, her expertise areas include ICD-9 and ICD-10 code sets, current procedural terminology (CPT) coding, and compliance for billing companies, as well as coaching teams and analyzing reports.



Dawn Duchek, Industry Initiatives Coordinator of Gateway EDI, researches healthcare industry trends and changes that could impact providers. She shares insights with clients and business partners to help them navigate and stay ahead of industry challenges. Dawn also educates internal associates about healthcare trends to help them better serve customers. Additionally, Dawn participates on the Gateway EDI 5010/ICD-10 implementation team. In this role, she is the contact for issues and questions about upcoming changes to healthcare transactions.


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