ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of 2 parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding

ICD-10-CM is for use in all US healthcare settings. Diagnosis coding under ICD-10-CM uses 3 to 7 alphanumeric characters instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in US inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric characters instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Additionally, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 has been adopted by almost every country in the world, except the United States.

On 4/1/2014, the President of the United States signed into law a legislative bill that included the delay of the ICD-10 compliance deadline until at least October 1, 2015. When the new date of compliance is announced, MDOL will notify all customers accordingly.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. The change to ICD-10 does not affect CPT coding for outpatient procedures.

Although HIPAA code set requirements apply only to HIPAA electronic transactions, the conversion applies to all paper-submitted claims as well.

The following table is a comparison of the differences in the features between the ICD-9-CM and ICD-10-CM code sets:

MD On-Line has assembled our internal transition team, and we are finalizing any needed changes, as well as end-to-end testing. We are developing solutions to assist you with the transition and provide options that will best fit your practice.

• WebLink™ – Please check with your existing Practice Management system to ensure that it will be ready for the ICD-10 transition.
• Link1500™ – Link1500™ will be ready to make the transition from ICD-9 to ICD-10 by the compliance date.
• InSync® Practice Management System (PM)/Electronic Medical Records (EMR) – InSync® is currently preparing our software to be ready for your use by September 2013. A claims scrubber will be added to guide you through the transition.
• Revenue Cycle Management (RCM) – Our RCM team will be going through extensive ICD-10 training and will ensure the ICD-10 medical necessities with a claim scrubber.
• Medical Transcription (MT) – Our professional transcriptionists are becoming familiar with the new medical terminology encompassed within the ICD-10 code set so that we can continue to monitor all quality parameters through every step of transcription and editing.
• Instinctive Data® (ID) – ID’s Provider Revenue Center is being updated to support both ICD-9 and ICD-10 classification systems, which will improve its abilities of analyzing claim data to deliver valuable information about your practice. Be sure to utilize Instinctive Data as your source for news and information on ICD-10 updates related to MD On-Line.

We encourage early awareness training for both clinical and administrative staff members; however, MD On-Line and our network of payers will not be able to process claims using ICD-10 until the approved date of compliance. MD On-Line will process claims submitted with ICD-9 codes for dates of service prior to the date of compliance—even if the claim is submitted after the compliance deadline. All claims submitted to MD On-Line for processing with dates of service on or after the date of compliance must be updated to use ICD-10 codes or they may be ineligible for reimbursement.

The ICD-10-CM/PCS code sets and the ICD-10-CM official guidelines are available free of charge at www.cms.gov/ICD10.

MD On-Line recommends the following steps:

1. Speak with your Practice Management software and/or vendor staff about their preparations and readiness and to determine your options.
2. Investigate staff training opportunities. Although MDOL does not offer ICD-10 training services for your practice, we recommend utilizing those offered through AAPC or CMS.
3. Compile a list of your most frequently used ICD-9 diagnosis codes and compare them with options in ICD-10. You may also need to update your internal forms with the new ICD-10 codes.
4. Contact your most frequently billed Insurance Payers regarding payment questions and your most utilized diagnosis codes.
5. Secure a budget that accounts for software upgrades/software license costs and staff training, as well as any workflow changes during and after implementation.
6. Develop a plan and a timeline, and determine any new system changes/processes; share the plans with your team to ensure all understand the extent of the effort the ICD-10 transition requires.

Dial (888) 499-5465 to speak with a sales or support representative. Representatives are available Monday through Friday from 8:30AM to 6:00PM EST. For online support, please log into your MDOL account and use our “Email Support” trouble ticketing system. To receive the latest news and resources on ICD-10, “like” us on Facebook or follow us on Twitter @MDOn_Line.