ICD-10 Diagnosis Codes FQA
1. Where can I find the slide presentation and
transcripts for the March 23, 2010 provider outreach conference call,
“Basic Introduction to ICD-10-CM”?
2. Where on the CMS website can I find more
information about ICD-10?
3. What are some of the benefits of ICD-10?
4. Will ICD-10 have an impact on Current Procedural
Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)
codes?
5. Will ICD-10 codes be used in all health care
provider type settings such as hospitals, physician offices, home health
visits, skilled nursing facilities, etc?
6. What should coders be doing now to prepare for
implementation of ICD-10?
7. Will the increased number of codes make
ICD-10-CM more difficult to use?
8. Will overly detailed medical record
documentation be required for ICD-10?
9. Will there be ICD-10 code books available in
hard copy or will all coding need to be performed
electronically?
10. Will there be a grace period for
implementation of ICD-10 compliance?
11. When will ICD-9 codes stop being
accepted?
12. For what period of time following
International Classification of Diseases, 10th Edition (ICD-10)
implementation on October 1, 2013 will the General Equivalence Mappings
(GEM) be updated?
13. How soon after a code has been added or
deleted will the General Equivalence Mappings (GEM) be updated to
reflect these changes?
14. When do you anticipate that an International
Classification of Diseases, 10th Edition (ICD-10) version of the
Medicare Severity Diagnosis Related Groups (MS-DRG) will be completed
and posted on the Centers for Medicare & Medicaid Services
website?
15. What methodology is being used in the Medicare
Severity Diagnosis Related Groups (MS-DRG) International Classification
of Diseases, 10th Edition (ICD-10) conversion?
16. We were told that validation of the General
Equivalence Mappings (GEM) is occurring as part of the conversion of the
current International Classification of Diseases, 9th Edition, Clinical
Modification (ICD-9-CM)-based Medicare Severity Dia
17. Were the General Equivalence Mappings (GEM)
designed for use by all providers and payers or was the focus on use
with Medicare data?
18. What process was used to develop the General
Equivalency Mappings (GEM)? Did the Centers for Medicare & Medicaid
Services (CMS) and the Centers for Disease Control and Prevention (CDC)
seek input from organizations such as the American Hospital Association
(AHA) and the American Health Information Management Association (AHIMA)
regarding the development of the GEMs? Did development of the GEMs
involve both clinical and coding evaluations?
19. Why do the General Equivalency Mappings (GEM)
go in both directions (from International Classification of Diseases,
9th Edition, Clinical Modification [ICD-9-CM] to International
Classification of Diseases, 10th Edition (ICD-10) and from ICD-10 back
to ICD-9-CM)?
20. Are there any instances when there is no
translation between an International Classification of Diseases, 9th
Edition, Clinical Modification (ICD-9-CM) code and an International
Classification of Diseases, 10th Edition (ICD-10) code? How do the
General Equivalency Mappings handle this situation?
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Where can I find the slide presentation and transcripts for
the March 23, 2010 provider outreach conference call, “Basic
Introduction to ICD-10-CM”?
Updated: 05/20/2010
You can find information from the March 23, 2010 provider outreach
conference call, "Basic Introduction to ICD-10-CM" on the CMS website Click here. Once on this page, scroll to the bottom
to the Downloads section you will find four files:
- Basic Introduction ICD-10-CM Slide Presentation
- ICD-10 Quick Reference Information
- Basic Introduction ICD-10-CM Written Transcript
- Basic Introduction ICD-10-CM Audio Transcript
Please note: Continuing education credits may be awarded by the
American Academy of Professional Coders (AAPC) or the American Health
Information Management Association (AHIMA) for participation in CMS
National Provider Conference calls.
Continuing Education Information for American Academy of Professional
Coders (AAPC)
If you have attended or are planning to attend one of CMS' National
Provider Conference Calls, you should be aware that CMS does not provide
certificates of attendance for these calls. Instead, the AAPC will
accept your e-mailed confirmation and call description as proof of
participation. Please retain a copy of your e-mailed confirmation for
these calls as the AAPC will request them for any conference call you
entered into your CEU Tracker if you are chosen for CEU verification.
Members are awarded one (1) CEU per hour of participation.
Continuing Education Information for American Health Information
Management Association (AHIMA)
AHIMA credential-holders may claim 1 CEU per 60 minutes of attendance
at an educational program. Maintain documentation about the program for
verification purposes in the event of an audit. A program does not need
to be pre-approved by AHIMA, nor does a CEU certificate need to be
provided, in order to claim AHIMA CEU credit. For detailed information
about AHIMA's CEU requirements, see the Recertification Guide on AHIMA's
web site.
The statements above are standard language provided to CMS by the
AAPC and the AHIMA. If you have any questions concerning either
statement, please contact the respective organization, not CMS.
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Where on the CMS website can I find more information about
ICD-10?
Updated: 05/20/2010
Additional information about ICD-10 can be found on the CMS website
at http://www.cms.hhs.gov/ICD10
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What are some of the benefits of ICD-10?
Updated: 05/20/2010
- Measuring the quality, safety, and efficacy of care
- Designing payment systems and processing claims for
reimbursement
- Conducting research, epidemiological studies, and clinical
trials
- Setting health policy
- Operational and strategic planning and designing healthcare delivery
systems
- Monitoring resource utilization
- Improving clinical, financial, and administrative performance
- Preventing and detecting healthcare fraud and abuse
- Tracking public concerns and assessing risks of adverse public
health events
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Will ICD-10 have an impact on Current Procedural Terminology
(CPT) and Healthcare Common Procedure Coding System (HCPCS) codes?
Updated: 05/20/2010
No, ICD-10 will not have an impact on Current Procedural Terminology
(CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. CPT
and HCPCS codes will continue to be used for physician and ambulatory
services, respectively.
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Will ICD-10 codes be used in all health care provider type
settings such as hospitals, physician offices, home health visits,
skilled nursing facilities, etc?
Updated: 05/20/2010
Yes, ICD-10-CM (diagnoses) will be used in all settings by all
providers while ICD-10-PCS (procedures) will be used only in the
inpatient hospital setting.
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What should coders be doing now to prepare for implementation
of ICD-10?
Updated: 05/20/2010
- Learn about the structure, organization, and unique features of
ICD-10-CM - all provider types
- Learn about the structure, organization, and unique features of
ICD-10-PCS - inpatient hospitals
- Learn about system impact and 5010
- Use assessment tools to identify areas of strength/weakness in the
biomedical sciences
- Review and refresh knowledge of biomedical concepts as needed based
on the assessment results
- Plan to provide intensive coder training approximately 6 -9 months
prior to implementation
- Allocating 16 hours of ICD-10-CM training will likely be adequate
for most coders, and very proficient ICD-9-CM coders may not need that
much
- Providing additional training may be needed to refresh or expand
knowledge in the biomedical sciences (anatomy, physiology,
pathophysiology, pharmacology, and medical terminology)
ICD-9 Notice: The International Classification of Diseases,
9thEdition, Clinical Modification (ICD-9-CM) is published by the United
States Government. A CD-ROM, which may be purchased through the
Government Printing Office, is the only official Federal government
version of the ICD-9-CM. ICD-9-CM is an official Health Insurance
Portability and Accountability Act standard.
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Will the increased number of codes make ICD-10-CM more
difficult to use?
Updated: 05/24/2010
No, a higher number of codes do not necessarily increase the
complexity of the coding system in fact; it makes it easier to find the
right code. Because ICD-10-CM is much more specific, is more clinically
accurate, and uses a more logical structure, it is much easier to use
than ICD-9-CM. Just as it isn't necessary to search the entire
list of ICD-9-CM codes for the proper code, it is also not necessary to
conduct searches of the entire list of ICD-10-CM codes.
The Alphabetic Index and electronic coding tools will continue to
facilitate proper code selection.
It is anticipated that the improved structure and specificity of
ICD-10-CM will facilitate the development of increasingly sophisticated
electronic coding tools that will assist in faster code selection.
ICD-9 Notice: The International Classification of Diseases, 9th
Edition, Clinical Modification (ICD-9-CM) is published by the United
States Government. A CD-ROM, which may be purchased through the
Government Printing Office, is the only official Federal government
version of the ICD-9-CM. ICD-9-CM is an official Health Insurance
Portability and Accountability Act standard.
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Will overly detailed medical record documentation be required
for ICD-10?
Updated: 05/24/2010
As with ICD-9-CM, ICD-10-CM codes should be based on medical record
documentation. While documentation supporting accurate and specific
codes will result in higher-quality data, nonspecific codes are still
available for use when documentation doesn't support a higher level of
specificity. As demonstrated by the American Hospital Association/
American Health Information Management Association field testing study,
much of the detail contained in ICD-10-CM is already incorporated in
medical record documentation but is not currently needed for ICD-9-CM
coding.
ICD-9 Notice: The International Classification of Diseases,
9thEdition, Clinical Modification (ICD-9-CM) is published by the United
States Government. A CD-ROM, which may be purchased through the
Government Printing Office, is the only official Federal government
version of the ICD-9-CM. ICD-9-CM is an official Health Insurance
Portability and Accountability Act standard.
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Will there be ICD-10 code books available in hard copy or
will all coding need to be performed electronically?
Updated: 05/20/2010
Hardcopy ICD-10-CM code books are available now and are a manageable
size. The use of ICD-10-CM is not based on the use of electronic
hardware and software, while these can certainly be used.
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Will there be a grace period for implementation of ICD-10
compliance?
Updated: 05/20/2010
October 1, 2013 is the compliance date for implementation of
ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) codes for services
provided on or after October 1, 2013. There will be no delays and no
grace period.
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When will ICD-9 codes stop being accepted?
Updated: 05/20/2010
ICD-9-CM codes will not be accepted for services provided on or after
October 1, 2013.
Note: ICD-10 codes will not be accepted for services
prior to October 1, 2013
ICD-9 Notice: The International Classification of Diseases, 9thEdition,
Clinical Modification (ICD-9-CM) is published by the United States
Government. A CD-ROM, which may be purchased through the Government
Printing Office, is the only official Federal government version of the
ICD-9-CM. ICD-9-CM is an official Health Insurance Portability and
Accountability Act standard.
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For what period of time following International
Classification of Diseases, 10th Edition (ICD-10) implementation on
October 1, 2013 will the General Equivalence Mappings (GEM) be
updated?
Updated: 06/03/2010
As we discussed on pages 3337-3338 of the ICD-10 final rule, the
ICD-9-CM Coordination and Maintenance Committee will discuss updating
the GEMs for a minimum of three years after ICD-10 is implemented on
October 1, 2013. We welcome recommendations regarding how long the GEMs
should be maintained and updated. The final rule can be found at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
on the Web.
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How soon after a code has been added or deleted will the
General Equivalence Mappings (GEM) be updated to reflect these
changes?
Updated: 06/16/2010
We update International Classification of Diseases, 9th Edition,
Clinical Modification (ICD-9-CM) and International Classification of
Diseases, 10th Edition (ICD-10) codes each year. The annual updates to
the GEMs along with the updates to the ICD-10 codes are posted on our
website at: http://www.cms.gov/ICD10.
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When do you anticipate that an International Classification
of Diseases, 10th Edition (ICD-10) version of the Medicare Severity
Diagnosis Related Groups (MS-DRG) will be completed and posted on the
Centers for Medicare & Medicaid Services website?
Updated 06/16/2010
A draft ICD-10 version of the MS-DRGs was completed in October 2009
and posted at http://www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_Project.asp.
We believe this exercise will provide useful information to other payers
who will be converting their own payment systems. The final ICD-10
version of the MS-DRGs will be subject to formal rulemaking as part of
the Inpatient Prospective Payment System.
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What methodology is being used in the Medicare Severity
Diagnosis Related Groups (MS-DRG) International Classification of
Diseases, 10th Edition (ICD-10) conversion?
Updated: 06/03/2010
The goal of MS-DRG ICD-10 conversion is to replicate the current
MS-DRG logic. A record coded in ICD-10-Clinical Modification/Procedure
Coding System (CM/PCS) and processed according to the converted
ICD-10-based MS-DRGs will be assigned to the same MS-DRG as the same
record coded in ICD-9-CM and processed according to the current MS-DRG
logic.
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We were told that validation of the General Equivalence
Mappings (GEM) is occurring as part of the conversion of the current
International Classification of Diseases, 9th Edition, Clinical
Modification (ICD-9-CM)-based Medicare Severity Dia
Updated: 06/16/2010
Will the GEMs be updated to correct any inaccuracies discovered
during any conversion application process? Any inaccuracies discovered
or brought to CMS' attention are noted so that changes can be made to
the affected GEMs and included in the next annual update. We will
continue to update the codes and GEMs on an annual basis.
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Were the General Equivalence Mappings (GEM) designed for use
by all providers and payers or was the focus on use with Medicare
data?
Updated: 06/03/2010
The GEMs were designed as a general purpose translation tool for all
types of providers, payers, and other users of coded data. The
translations are based on the meaning of the code as contained in the
tabular instruction, index entries, and applicable Coding Clinic advice.
They were developed independently without reference to Medicare data.
Their applicability extends equally to all types of users-providers,
payers, researchers, and application development vendors.
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What process was used to develop the General Equivalency
Mappings (GEM)? Did the Centers for Medicare & Medicaid Services
(CMS) and the Centers for Disease Control and Prevention (CDC) seek
input from organizations such as the American Hospital Association (AHA)
and the American Health Information Management Association (AHIMA)
regarding the development of the GEMs? Did development of the GEMs
involve both clinical and coding evaluations?
Updated: 06/03/2010
The GEMs were developed over a period of three years by CMS and CDC,
with input from both AHA and AHIMA. The GEMs development and maintenance
team includes clinicians and coding experts, representatives of the
Cooperating Parties (CMS, CDC, AHA, and AHIMA), and the team that
developed and maintains International Classification of Diseases, 10th
Edition, Procedure Coding System. The General Equivalence Mappings
User's Guides were collaboratively written by the Cooperating Parties.
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Why do the General Equivalency Mappings (GEM) go in both
directions (from International Classification of Diseases, 9th Edition,
Clinical Modification [ICD-9-CM] to International Classification of
Diseases, 10th Edition (ICD-10) and from ICD-10 back to ICD-9-CM)?
Updated: 06/03/2010
The GEMs are designed to be used like a bi-directional translation
dictionary. They go in both directions so that you can look up a code to
find out what it means according to the concepts and structure used by
the other coding system, similar to how Spanish-English and
English-Spanish dictionaries are designed. Neither the two dictionaries
nor the GEMs are a mirror image of each other. Because the translation
alternatives are based on the meaning of the code you are looking up
(which includes index entries, tabular instruction, and applicable
Coding Clinic advice), the ICD-10-Procedure Coding System (PCS) to
ICD-9-CM GEM is not a mirror image of the ICD-9-CM to ICD-10-PCS
GEM.
The GEMs were designed to convert current ICD-9-CM codes to
applicable ICD-10 codes. A "reverse lookup" of the backward mappings
(ICD-10-CM/PCS to ICD-9-CM GEM, looked up by ICD-9-CM code) can be used
to convert payment logic or coverage decisions from ICD-9-CM codes to
ICD-10 codes. This mapping (ICD-10-CM/PCS to ICD-9-CM GEMs) could also
be used in examining trend data over multiple years, spanning the
implementation of ICD-10. For example, in 2013 it will be possible to
compare how frequencies changed for a specific condition using an ICD-10
code compared to prior years using ICD-9-CM codes. The forward mapping
(ICD-9-CM to ICD-10-CM/PCS GEMs) can be used to convert ICD-9-CM-based
edits and can also be used for any analysis or conversion project that
needs to examine ICD-10 codes and determine the ICD-9-CM code(s) that
previously captured this diagnosis or procedure.
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Are there any instances when there is no translation between
an International Classification of Diseases, 9th Edition, Clinical
Modification (ICD-9-CM) code and an International Classification of
Diseases, 10th Edition (ICD-10) code? How do the General Equivalency
Mappings handle this situation?
Updated: 06/16/2010
Yes, there are instances where there is not a translation between an
ICD-9-CM code and an ICD-10 code. When there is no plausible translation
from a code in one system to any code in the other
system, the "No Map" flag indicates this. For example, the following
codes are marked with the "No Map" flag:
- ICD-10-CM code Y71.3 - Surgical instruments, materials and
cardiovascular devices (including sutures) associated with adverse
incidents, which has no reasonable translation in ICD-9-CM; and
- ICD-9-CM procedure code 89.8 - Autopsy, which has no reasonable
translation in ICD-10-Procedure Coding System.
For more information on this subject, see the Diagnosis Code Set
General Equivalence Mappings ICD-10-CM to ICD-9-CM and ICD-9-CM to
ICD-10-CM Documentation and User's Guide, which can be accessed at
http://www.cms.gov/ICD10. Look
on the left side for the most recent ICD-10-CM link. Click on this link.
The GEMS User's Guide is posted in the Downloads Section within the
zipped files.
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