International Classification of Diseases, 10th Edition (ICD-10)

The transition to ICD-10 is necessary due to the data limitations ICD-9 produces related to patients’ conditions and hospital inpatient procedures. ICD-9 is outdated, inconsistent with current medical practice and limits the creation of new codes.  ICD-10 provides an expanded set of diagnosis (ICD-10-CM) and procedure (ICD-10-PCS) codes to keep pace with medical and technological advances. 

In preparation for the full implementation of ICD-10 code sets on October 1, 2015, the Iowa Medicaid Enterprise (IME) encourages all providers to test ICD-10 claim submissions. Testing ICD-10 Claim Submission with the IME.
Relevant information on ICD-10

1-800-338-7909 (Toll-Free), 515-256-4609 (in Des Moines) (Email)

News and Announcements
  • ICD-10 Provider Readiness Survey #4 Result: IME survey result reveals progressive trend among providers toward implementation of ICD-10 as October 1, 2015 deadline approaches. See the result of the fourth provider readiness survey.

  • Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets: Federal Register document on the change to the compliance date for ICD-10 code sets to October 1, 2015.

  • The Iowa Medicaid Enterprise (IME) continues progress toward implementation of ICD-10: The delay allows providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to the new ICD-10 code set.  The IME ICD-10 testing environment continues to be available for testing of provider claims.  Providers are encouraged to move forward with their ICD-10 projects and to test ICD-10 claim submissions as soon as they are ready to do so.

Benefits of ICD-10
The ICD-10 code set provides significant benefits in the areas of program management, care management, quality management, and cost analysis:

Includes enhanced clinical condition description and code specificity greater than 68,000 ICD-10-CM diagnosis codes and 87,000 ICD-10-PCS procedure codes for:

  • Improved ability to measure quality of health care, complications, and clinical outcomes
  • Public health surveillance refinement
  • Mortality and morbidity classification
  • Increased sophistication with diagnosis related grouping (DRG) and reimbursement methodologies enhancing accurate payment for health services rendered 

Allows for unrestricted code creation and expansion as new medical conditions are identified and new medical technologies emerge (ICD-10-CM diagnosis codes have 3–7 alphanumeric digits instead of the 3–5 digits used with ICD-9 and ICD-10-PCS procedure codes have 7 alphanumeric digits instead of the 3-4 numeric digits used with ICD-9.)

Supports the transition to an interoperable health data exchange positively impacting the quality and usability of information

Testing ICD-10 Claim Submission with Iowa Medicaid
In preparation for ICD-10 implementation, Iowa Medicaid encourages all providers to begin testing ICD-10 claim submissions as soon as possible.

  • Direct submitters of claims to the Iowa Medicaid Electronic Data Interchange Support Service (EDISS) who are ready now, can test claim submissions to Iowa Medicaid using EDISS Connect. Access instructions for testing Claim Submission via EDISS Connect.
  • Providers who submit claims via a vendor are encouraged to communicate with the vendor to ensure ICD-10 Medicaid claim submission testing is done on their behalf.

ICD-10 Frequently Asked Questions
Please see the Frequenly Asked Questions document for answers to the most commonly encountered questions involving IME ICD-10. 

Iowa Medicaid ICD-10 Informational Letters
The following IME information letters have been published regarding ICD-10 implementation.

  • 1379 - ICD-10 Implementation Delayed (April 21, 2014)
  • 1366 - Diagnosis Related Group (DRG) Impact Fiscal Analysis for ICD-10 Implementation (March 17, 2014)
  • 1362 - ICD-10 Testing of Claim for Seamless Transition (February 26, 2014)

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Iowa Medicaid ICD-10 Provider Readiness Survey
The IME will conduct quarterly surveys to assess the readiness of IME providers prior to the October 1, 2015 launch date of ICD-10. 

Previous Provider Readiness Survey Results

Centers for Medicare and Medicaid Services (CMS) ICD-10 Resources
CMS provides extensive information, tools and resources for implementing ICD-10.  These links will assist with ICD-10 planning and implementation.

  • CMS Road to 10 assists small medical practices with the ICD-10 transition.
  • CMS ICD-10 FAQs address common ICD-10 questions and point to additional resources.
  • CMS Provider Resources provide access to an abundance of ICD-10 transition tools, resources, checklists and timelines.
  • 2015 ICD-10-CM (Diagnosis) General Equivalence Mappings (GEMs) are mappings between ICD-10 and ICD-9 diagnosis codes designed to assist in converting systems and applications from ICD-9 to ICD-10 codes. GEMs are updated annually.
  • 2015 ICD-10-PCS (Procedure) General Equivalence Mappings (GEMs) are mappings between ICD-10 and ICD-9 procedure codes designed to assist in converting systems and applications from ICD-9 to ICD-10 codes. GEMs are updated annually.
  • ICD-10 MS-DRG Conversion Project used the GEMs to convert the draft MS-DRGs (version 29) to ICD-10 to better understand the potential financial impacts of the transition to ICD-10. Impact Article updated on February 25. 2013 provides an overview of the estimated financial impact of the transition to ICD-10 on Medicare inpatient hospital payments.

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Other ICD-10 Professional Resources

Medical Organizations:
Health Information Management and Data Transfer Resources: