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ICD-10 Resource Center
ICD-10 Resource Center

We are committed to keeping you informed about ICD-10 updates through our provider newsletter and other communications. This section of our website is intended to provide the most current information and resources available related to ICD-10.

The current Center of Medicare & Medicaid Services (CMS) ICD-10 compliance date is October 1, 2015. As of October 1, we will be ready to accept ICD-10 codes on claims based on dates of service (outpatient) or dates of discharge (inpatient). The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

Providers will be required to submit Health Insurance Portability and Accountability Act (HIPAA)-compliant transactions in version 5010. As of October 1, all HIPAA-covered entities must use the new ICD-10 code sets.

The current ICD-9 code sets are out-of-date due to their limited ability to accommodate new procedures and diagnoses. ICD-10 incorporates greater specificity of codes - more clinical information contained in the codes - and updated terminology.

Use of ICD-10 will:
  • Improve the ability to measure health care services
  • Enhance the ability to monitor the populations' health
  • Provide better overall data and decrease the need for supporting documentation needed when submitting claims
 
What is ICD-10?
Effective October 1, 2015, all health care entities must use ICD-10 codes on HIPAA transactions, including:
  • Diagnosis codes (ICD-10-CM) used by all providers in every health care setting
  • Procedure codes (ICD-10-PCS) only used for hospital claims and inpatient hospital procedures
 
What are the effective dates?
After October 1, 2015, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the October 1 compliance date.
 
What is different?
ICD-10 codes length and structure differ from ICD-9 codes. In addition, ICD-10 codes:
  • Contain more detail about conditions, injuries and illnesses
  • Include the concept of laterality
  • Use combination codes to describe conditions and associated symptoms
  • Use updated language and terminology
 
How do I prepare?
  • Learn about the structure and differences of the ICD-10 code set
  • Look at your organization and see what it will take to make the change
  • Train coders on ICD-10 prior to October 1, 2015 Talk with your vendors, payers, clearinghouses, billing services about ICD-10 readiness
  • If you have not already started to prepare it is important that you start now!
  • Review the resources and tools on the CMS website (http://www.cms.gov/ICD10/) to help ensure a smooth transition.
 
What is our health plan’s position on ICD-10 implementation?
  • We have remediated all of our systems to be ICD-10 compliant. ICD-10 testing with our providers is underway and will continue through the beginning of September 2015.
  • If you are interested in testing with our health plan, please email your practice contact information to ICD-10.Test.Team.Communications@excellus.com and you will be contacted via email with updates. Please do not include any other confidential information in this email request.
  • Follow this link to learn more about our position on ICD-10 implementation (PDF).