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ICD-10 Frequently Asked Questions

|Question |Answer |

|What is ICD? |ICD is the International Classification of Diseases published by the World Health Organization (WHO). It is a |

| |statistical classification system that describes diagnosis and procedure information. For more information: |

| | or |

| | |

|What is the ICD-10 deadline? |The effective date is October 1, 2014. All bills submitted on or after 10/1/2014 must have ICD-10 codes assigned. |

|How is ICD-10 different than ICD-9? |ICD-10 CM (diagnosis) codes will utilize 3-7 characters as opposed to the ICD-9 CM, with 3-5 characters. The |

| |number of ICD-10 codes is approximately 68,000 versus 13,000 for ICD-9 CM. ICD-10 codes will be very specific, |

| |precise, and include laterality (right vs. left). |

| |ICD-10 CM codes have a seventh character extension to identify encounter status (e.g., initial, subsequent and |

| |sequelae). Full code set and guidelines are available at: ICD10 |

| |Example: |

| |ICD-9 CM: 812.49 – Fracture of humerus, other |

| |ICD-10 CM: S42.481G – Torus fracture of lower end of right humerus, subsequent encounter for delayed healing |

| | |

| |ICD-10 PCS (procedure) codes, used only in inpatient hospital settings, will utilize 7 characters compared to |

| |ICD-9 PCS’s 3-4 characters. ICD-10 PCS will have over 72,000 codes versus ICD-9 PCS’s 3,000 codes. ICD-10 PCS |

| |codes will be much more specific and the format will be significantly different than ICD-9 PCS. Each ICD-10 PCS |

| |code will include the name of the coding section (e.g., Medical Surgical), body system, root operation, body part,|

| |procedure approach, device, and a qualifier. The full code set and guidelines are available at: ICD10 |

| |Example: |

| |ICD-9 PCS: 39.24 – Aorto-Renal Bypass |

| |ICD-10 PCS: 04104J3 – Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, Percutaneous |

| |Endoscopic Approach |

|Why move to ICD-10 codes? |The current ICD-9 code classification is over 30 years old and outdated. The current structure limits any |

| |expansion, as many ICD-9 categories are already full. ICD-10 allows for more flexibility in adding new codes and |

| |improves data content due to improved specificity. The intent of ICD-10 is to improve quality of care, reporting, |

| |and claim handling. |

|Will CPT procedure codes be impacted?|No, CPT procedure codes are not impacted. CPT procedure codes for outpatient procedures are not impacted. |

|Who will be impacted by ICD-10? |ICD-10 impacts HIPAA-covered entities. This includes providers and payers who submit and do not submit Medicare |

| |claims. |

|What if I am not a HIPAA covered |The IAIABC and CMS have made recommendations for the adoption of ICD-10 to all non-covered entities by 10/1/2014. |

|entity? | |

| | |

|Will ICD-9 codes be used after |There is the possibility that ICD-9 codes (or both ICD-9 and ICD-10 codes) may be used in workers’ compensation |

|10/1/2014? |states that have yet to officially adopt migration to ICD-10. |

|What is GEM? |GEM is General Equivalence Mapping developed by CMS, CDC, AHIMA, and AHS as a tool to convert ICD-9 CM codes to |

| |ICD-10 CM, and backward convert ICD-10 CM to ICD-9 CM codes. |

|How is GENEX preparing for ICD-10? |GENEX is evaluating all services, product applications, and interfaces that will be impacted by the ICD-10 |

| |transition. We are also performing outreaches to all of our customers, vendors, and trading partners as part of |

| |our impact analysis. Detailed project plans are in development. GENEX will work closely with our customers to |

| |assist them with ICD-10 modifications. All GENEX services and systems will be tested and ICD-10-compliant prior to|

| |the 10/1/2014 deadline. |

|What should I do to prepare for |The process of implementing ICD-10 is complex and will impact all aspects of medical provider practice and |

|ICD-10? |reimbursement. It is recommended that planning, inventory, and analysis of your system applications, workflow |

| |processes, interfaces, and other activities start as soon as possible. Develop a detailed project plan, complete |

| |project requirements, secure development resources, create a testing plan, and identify ICD-10 training needs. |

|Who needs ICD-10 training? |The following may need some amount of ICD-10 CM and ICD-10 PCS training: |

| |Clinicians (physicians, therapists, nurses, etc.) |

| |Billing office professionals |

| |Auditors/Coding Reviewers |

| |Case Managers/Utilization Managers |

| |Claim Adjusters |

| |Bill Reviewers |

| |Information technology personnel |

| |Data analysts |

| |Patient registration staff |

| |Corporate compliance office staff |

| |Health information management staff (health records, billing) |

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