ICD-10 Information

You must use: ICD-10 codes for all services provided on or after October 1, 2015
                 ICD-9 codes for all services provided before October 1, 2015

The U.S. Department of Health and Human Services (HHS) published a final rule to adopt ICD-10 as the HIPAA standard code sets to replace the previously adopted ICD–9–codes for diagnosis and procedure codes in the HIPAA Administrative Simplification; Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS, 74 FR 3328. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

In August 2014, HHS issued a rule finalizing October 1, 2015, as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the 10th revision of the International Classification of Diseases.

Claims for all health care services with dates of service on or after October 1, 2015, and all hospital inpatient claims with discharge dates on or after October 1, 2015, must use the ICD-10 code sets.

Implementation of ICD-10 will:

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  • accommodate new procedures and diagnoses unaccounted for in the ICD-9 code set;
  • allow for greater specificity of diagnosis-related groups and preventive services; and
  • allow for improved accuracy in reimbursement, fraud detection, historical claims and diagnoses analysis for the health care system.

 

For questions and/or to provide feedback about the ICD-10 implementation, please contact us via email at RA-pwomapicd10@pa.gov
To join our ICD-10 Listserv click here.

 Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

Update from Secretary Ted Dallas (July 13, 2015)

Resources

General ICD-10 Information
Fact Sheets
Quick Tips
Medical Assistance Bulletins
Federal Register