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A Quick Guide to ICD-10: What You Need to Know

What is ICD-10 and Why Does it Matter?

The 10th revision of the International Classification of Diseases (ICD-10) was approved by the World Health Organization (WHO) in 1990. Like its predecessor ICD-9, it is a coding method for healthcare professionals designed to best reflect each patient’s state of health and the institutional procedures used in patient care. The ICD-10 has added over 125,000 new diagnosis and procedure codes, making it the most accurate and comprehensive coding system to date. Beginning on October 1st, 2015 the ICD-10 will go into effect nationwide, replacing the limited patient data, outdated terminology, and inconsistent methods of the 30-year-old ICD-9 system.

The transition from ICD-9 to ICD-10 affects everyone covered by HIPAA, including all acupuncturists, rehab therapists, other providers, payers, clearinghouses, and billing services (like us!).

What Do I Really Need to Know?

  • The ICD-10 transition is necessary and mandatory
  • ICD-9 codes are no longer valid for dates of service after October 1st, 2015
  • ICD-9 codes are still valid for dates of service before October 1st, 2015
  • There is a significant increase in diagnosis codes (68,000 codes)
  • All codes are listed by specific body part and placement
  • ICD-10 codes will NOT replace the standard acupuncture CPT codes
  • ICD-10 affects everyone covered by HIPAA
  • Although the mandate was for electronic billing, ICD-10 codes are required for paper claims submission. ICD-10 codes may also be required for bills submitted by fax, over the phone or traditional mail. (Please see the American Medical Association Frequently Asked Questions (FAQ) for more info.)
  • Acubiller has an ICD-10 compliant Superbill for all clients to use (Email Eliza if you haven’t already received yours!)

What Can I Expect?

The Good:

  • Improved treatment records based on increased specificity of codes
  • More accurate reimbursements
  • Potential for higher compensation (no promises!)

The Bad:

  • Increased claim denials now that there are more codes to be denied
  • Claim processing delays as the insurance companies make the transition
  • General confusion and delays

About the ICD-10 Codes

In the U.S., the ICD-10 includes two distinct code sets: ICD-10-CM and ICD-10-PCS.

ICD-10-CM is for use in all American health care settings. ICD-10-CM codes use 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.

Example: Lower Back Pain – Lumbosacral Spine
ICD-9 code: 724.2
ICD-10 code: M54.5

ICD-10-PCS is for use in U.S. inpatient hospital settings only and does not apply to Acubiller or our clients.

Is Acubiller prepared?

But, of course! Acubiller staff have been hard at work for months preparing for the ICD-10 transition. Our new Superbill has been painstakingly designed to include a huge collection of codes from every major carrier. Acubiller clients can now use this new tool for better and more accurate claims processing.

The insurance carriers may still have some difficulties with the ICD-10 transition, however, so we’d like to encourage our clients to have patience in the coming months.

How can I find ICD-10 codes?

More Information & Resources

Official CMS ICD-10 Website
AMA ICD-10 Frequently Asked Questions (FAQ)