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ICD-10-CM/PCS
ICD-10 Compliance Timeline
December 31, 2010
• Internal testing of HIPAA version 5010 must be complete to achieve level I version 5010 compliance
• Version 5010 is required for ICD-10
January 1, 2011
• Payers and providers should begin external testing of version 5010 for electronic claims
• CMS begins accepting version 5010 claims
• Version 4010 claims continue to be accepted
December 31, 2011
• External testing of Version 5010 for electronic claims must be complete to achieve level II version 5010 compliance
January 1, 2012
• All electronic claims must use version 5010
• Version 4010 claims are no longer accepted
October 1, 2013
• Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures
• CPT codes continue to be used for outpatient services
What is ICD-10?
“ICD-10” is the abbreviated term used to refer to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).
• ICD-10-PCS 
is the code set of inpatient procedure codes and is the updated version of ICD-9-CM Volume 3.
is the code set of inpatient procedure codes and is the updated version of ICD-9-CM Volume 3.The history of the International Classification of Diseases (ICD) extends back to the late 19th century, when the need for standardizing classification concepts and terminology was recognized by the medical community in Europe. Since 1900, the ICD for mortality has been modified about once every ten years, except for the 20-year interval between the ICD-9 and ICD-10.
Implementing revised Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards and ICD-10 codes could potentially have the largest operational and technological impacts on the health care industry since Y2K. It’s also a significant undertaking for health insurance plans that requires extensive planning and execution.
The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a technical advisory panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility.
Implementation date
The compliance date for implementation of the ICD-10-CM/PCS is October 1, 2013.
The benefit of ICD-10
ICD-10-CM/PCS will:
• Enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes
• Provide significant improvements through greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine.
Comparing ICD-10 to ICD-9
Each successive revision has a similar core to the previous revision. However, ICD-10 differs from ICD-9 in the following respects:
• ICD-10 is far more detailed than ICD-9 with about 8,000 categories compared with 4,000 categories.
• ICD-10 transfers conditions among the classifications. For example, hemorrhage has been moved from the "circulatory" chapter to the "symptoms and signs" chapter.
• ICD-10 uses 4-digit alpha-numeric codes instead of the 4-digit numeric codes used in ICD-9.
• ICD-10 changes some coding rules. For example, the rules for coding "pneumonia and influenza," "maternal conditions," and "error and accidents in medical care" have been changed.
• ICD-10 provides new tabulation lists (e.g. the 113 causes list in the U.S. ICD-10 113 replaces the 72 causes list in the U.S. ICD-9).
Tabulation lists
The leading causes of death are determined using a specific tabulation list and rules for ranking. In ICD-10, the 113 causes list is used for ranking all deaths except infant deaths, which are ranked separately on a list of 130 causes. ICD-10 also provides a list of 39 selected causes of death, which is used to show mortality data for geographic areas, a list of 124 selected causes of fetal death, and a list of motor vehicle accident deaths.
Education resources
The following are resources designed to assist providers during and after the ICD-10 implementation process:
• The Introduction to ICD-10-CM/PCS for Physician Specialty Group Representatives Presentation 
: Provides information and resources that physician specialty group representatives may use to conduct ICD-10 implementation training for their members.
: Provides information and resources that physician specialty group representatives may use to conduct ICD-10 implementation training for their members.• General ICD-10 Information : This page provides overview information related to ICD-10, Procedure Coding System (PCS) and Clinical Modifications (CM).
: This page provides overview information related to ICD-10, Procedure Coding System (PCS) and Clinical Modifications (CM).• FCSO ICD-10 FAQs: Here you will find related frequently asked questions developed by First Coast Service Options Inc.
• ICD-10-CM/PCS -- An Introduction (The Next Generation of Coding) : This fact sheet provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9-CM and ICD-10-CM/PCS, and implementation planning recommendations.
: This fact sheet provides general information about the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) including benefits of adopting the new coding system, structural differences between ICD-9-CM and ICD-10-CM/PCS, and implementation planning recommendations. • ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project : This presentation describes how ICD-9-CM based Medicare Severity -- Diagnosis Related Group (MS-DRG), version 26.0, was converted to ICD-10-CM and ICD-10-PCS codes and the best way to use the general equivalence mappings in converting data.
: This presentation describes how ICD-9-CM based Medicare Severity -- Diagnosis Related Group (MS-DRG), version 26.0, was converted to ICD-10-CM and ICD-10-PCS codes and the best way to use the general equivalence mappings in converting data.• ICD-10-CM/PCS Myths & Facts : Presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System.
: Presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System.• General Equivalence Mappings -- ICD-9-CM to and from ICD-10-CM and ICD-10-PCS : Provides information and resources regarding the general equivalence mappings that were developed as a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM.
: Provides information and resources regarding the general equivalence mappings that were developed as a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM.• The Second in Series: General Equivalence Mappings -- ICD-9-CM to and from ICD-10-CM and ICD-10-PCS Fact Sheet : Provides basic information about the GEMs including possible users of the GEMs, why the GEMs are needed, and how the GEMs files are formatted as well as reimbursement mappings information.
: Provides basic information about the GEMs including possible users of the GEMs, why the GEMs are needed, and how the GEMs files are formatted as well as reimbursement mappings information.• ICD-10-CM/PCS Implementation and General Equivalence Mappings (Crosswalks) Overview Presentation : This presentation provides the following information: an overview of the ICD-10 final rule, which requires the implementation of ICD-10-CM/PCS on October 1, 2013; the differences between ICD-9-CM and ICD-10-CM/PCS codes; the use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and the resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS.
: This presentation provides the following information: an overview of the ICD-10 final rule, which requires the implementation of ICD-10-CM/PCS on October 1, 2013; the differences between ICD-9-CM and ICD-10-CM/PCS codes; the use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and the resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS.Other external resources
The resources below are external to the FCSO and Centers for Medicare & Medicaid Services (CMS) Web sites, but are being offered for your convenience. FCSO and CMS are not responsible for the content or maintenance of these external sites.
• AAPC Web resources : At this site you will find ICD-10 news and information from the American Academy of Professional Coders (AAPC).
: At this site you will find ICD-10 news and information from the American Academy of Professional Coders (AAPC).• AHIMA Web resources : The American Health Information Management Association (AHIMA) website shares information and training sessions for ICD-10.
: The American Health Information Management Association (AHIMA) website shares information and training sessions for ICD-10.• HIMSS Web resources : The Health Information and Management Systems Society (HIMSS) website offers ICD-10 information and guidance.
: The Health Information and Management Systems Society (HIMSS) website offers ICD-10 information and guidance.• CDC Web resources : The Centers for Disease Control and Prevention website offers ICD-10 information.
: The Centers for Disease Control and Prevention website offers ICD-10 information.