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


In preparation for the full implementation of ICD-10 code sets, Iowa Medicaid encourages all providers to test ICD-10 claim submissions as soon as possible. Direct submitters of claims to the Iowa Medicaid Electronic Data Interchange Support Services (EDISS) who are ready to test now, can test claim submissions to Iowa Medicaid using EDISS Connect. Instructions for initiating the ICD-10 claim submission test process can be accessed in Informational Letter 1379. 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. For more information regarding ICD-10 codes and the mandate to change to these new code sets, please visit the CMS ICD-10 web site at http://www.cms.gov/icd10.


KEY CONTACT INFORMATION FOR ICD-10 GROUP
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News and Announcements
  • News on the delay to 2015
  • News article 2
  • News article 3

Results of previous ICD-10 Provider Readiness Surveys:

ICD-10 Compliance Date

Press Release on the ICD-10 Compliance Date Delay

Federal Register posted the final rules on September 5, 2012 indicating the ICD-10 deadline be extended to October 1, 2014.

ICD-10 Basics and Benefits

ICD-10 Basics:
ICD-10-CM and PCS (International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System) is an update to the ICD-9 and provides and expanded set of diagnosis and procedure codes to keep pace with advances in medicine over the last three dacades. Another primary reason driving the migration from ICD-9 to ICD-10 is that the ICD-9 code set is running out of codes and its limited structural design is preventing the addition of new codes. ICD-10 consists of:

  • ICD-10-CM for diagnosis coding in all health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
  • ICD-10-PCS for procedure coding in inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used with ICD-9-CM procedure coding and is much more specific. The format of the code sets is substantially different.

ICD-10 Benefits:
The ICD-10 code sets provide significant benefits in areas such as program management, care management, and analysis of program costs and effectiveness and:

  • Incorporate much greater specificity and clinical information for: improved ability to measure health care services, increased sensitivity when refining grouping and reimbursement methodologies, enhanced ability to conduct public health surveillance, and decreased need to include supporting documentation with claims
  • Include updated medical terminology and classification of diseases
  • Provide codes to allow comparison of mortality and morbidity data
ICD-10 Resources

Centers for Medicare &Medicaid Services (CMS)
CMS provides extensive information, tools, and resources for implementing ICD-10. We are providing select links to assist you with your ICD-10 efforts. For more information, visit the CMS website at cms.gov.

45 CFR Part 162, Final Rule: Governing legislation for implementing the ICD-10 code sets.

Medicaid.gov: A CMS website with Federal policy guidance, lists of pending and approved waivers, highlights of CMS Affordable Care Act implementation efforts, State-specific program information and data, and search capabilities.

CMS ICD-10 Website: Provides resources for providers, payers and vendors, including ICD-10 implementation timelines, Fact Sheets, GEMs (see below), trainings, and links to other resources to help with the transition to ICD-10 code sets.

CMS Informational Bulletins: CMS publishes Informational Bulletins about a variety of topics, including ICD-10. You can sign up to receive these bulletins when they are released.

CMS ICD-10 Code Conversion Software: An announcement that CMS selected the 3M ICD-10 Code Conversion Software to assist them with their ICD-10 implementation efforts.

2012 ICD-10-CM General Equivalence Mappings (GEMs): GEMs are mappings between ICD-10-CM and PCS and ICD-9-CM codes. They are designed to assist in converting applications and systems from ICD-9 to ICD-10 codes and are updated annually.

ICD-10 MS-DRG Conversion Project: The Medicare Severity-Diagnosis-Related Grouping (MS-DRG) conversion project used the General Equivalence Mappings (GEMs) to convert the draft MS-DRGs v29.0 to ICD-10-CM and ICD-10-PCS to understand the potential impacts of the change in code sets.

Medicare Learning Network (MLN): The Medicare Learning Network (a registered trademark of CMS), provides CMS educational products and information for Medicare Fee-For-Service (FFS) Providers.

American Medical Association (AMA)
The AMA is a professional organization for physicians and provides resources on professional and public health issues, including the conversion to ICD-10 code sets.

AMA ICD-10 Website. This link takes you to the AMA's ICD-10 web page, which contains links to many resources.

AMA Wire. A weekly electronic newsletter that is searchable by topic. You can subscribe to the weekly newsletter.

American Health Information Management Association (AHIMA)
AHIMA is a resource for health information management (HIM), education, accreditation, professional credentialing, standards-setting, policy-making, and issue advocacy.

AHIMA Website: Provides online training courses, ICD-10 news, and other features; however, some resources are only available to members.

IaHIMA Website: The Iowa Health Information Management Association is a state organization affiliated with the national organization AHIMA. IaHIMA develops, promotes, and advances the Health Information Management profession in Iowa.

American Academy of Professional Coders (AAPC)
AAPC provides education and professional certification to physician-based medical coders and provides student training, certification, ongoing education, and networking.

AAPC ICD-10 Website: Provides resources and ICD-10 coding training and certification.

WEDI (Workgroup for Electronic Data Interchange)
WEDI provides a broad-based interactive forum for healthcare executives, managers, and advisors to utilize in addressing the business issues and policy formulation for the industry. (Registration or membership is required to access some information and resources.)

WEDI Website: Among the organization's activities are ICD-10 White Papers and quarterly ICD-10 surveys.

WEDI ICD-10 White PaperImplementation: This white paper is intended to provide industry guidance on building an Implementation Plan for compliance with the Final Rule regarding ICD-10.

WEDI ICD-10 White PaperRedefining Policies, Rules, and Categories: This white paper focuses on the methods and issues related to redefining policies, rules and categories that use groups of diagnostic or inpatient hospital procedure codes in algorithms or categories of analysis.

WEDI March 2012 Town Hall Presentation: A March 2012 Town Hall meeting presentation that includes a section on ICD-10 progress.

Other ICD-10 Resources

The following are websites related to ICD-10.

WHO ICD Website. The World Health Organization (WHO) provides you with links and downloads to help you better understand ICD coding and the transition from ICD-9 to ICD-10.

CDC ICD-10-CM Website. The Center for Disease Control (CDC) provides information about ICD-10-CM on its website.