ICD-10 Compliance FAQs (Security Health Plan)

ICD-10ICD-10 compliance means that a HIPAA-covered entity uses codes for health care services provided on or after October 1, 2015. ICD-9 diagnosis and inpatient procedure codes cannot be used for services provided on or after this date. This code set deadline has been delayed by the federal government until no earlier than  October 1, 2015.

Will version 10 replace Current Procedural Terminology (CPT) coding?

No. The transition to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Like ICD-9 procedure codes, version 10-PCS codes are for hospital inpatient procedures only.

Who is affected by the transition to ICD-10?

All health care providers, clearinghouses, payers and other entities covered by HIPAA will be required to use version 10 when it goes into effect. Organizations that are not covered by HIPAA, but use ICD-9 codes should be aware that their coding may become obsolete if they do not transition to ICD-10.

Making the Transition to ICD-10 Is Not Optional

Claims for all health care services and hospital inpatient procedures performed after the effective date must use version 10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that  use ICD-9 diagnosis and inpatient procedure codes, rather than version 10, cannot be processed. It is important to note, however, that claims for services provided before the effective date of version 10 must use ICD-9 diagnosis and inpatient procedure codes.

Will I need to use both code sets during the transition?

Practice management systems must be able to accommodate both ICD-9 and ICD-10 codes until all claims and other transactions for services before the version 10 effective date have been processed and completed. Promptly processing ICD-9 transactions as the transition date nears will help limit disruptions and will limit the timeframe when dual code sets need to be used.

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