Frequently Asked Questions on ICD-10

What is ICD-10?

ICD-10 is the abbreviated way to refer to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS). Developed by the World Health Organization, this version was released in 1993 and contains about 70,000 specific codes. (Read more about Upstate's approach to ICD-10.)

Explain the difference between ICD-10-CM and ICD-10-PCS.

ICD-10-CM is the diagnosis code set that will be replacing ICD-9-CM, Volumes 1 and 2. ICD-10-CM will be used to report diagnoses in all clinical settings. ICD-10-PCS is the procedure code set that will be replacing ICD-9-CM, Volume 3. ICD-10-PCS will be used to report hospital inpatient procedures only.

Who will be affected by the change to ICD-10?

Those most affected will be health care providers who enter the codes into the patient's record, such as physicians, nurse practitioners, physician assistants and physical therapists. Also affected, among others, will be the medical coders and others who deal with the records, such as those working with billing and claims. Nurses, for example, will need to support the thorough and accurate observation and documentation that the new coding demands.

Where can I go for help?

Upstate has set up an internal ICD-10 coding hotline at 464-7809, that for now is answered live by a lead coder from 8 a.m. to 4:30 p.m. Monday through Friday. For coding questions that specifically deal with EPIC, call the usual IMT help desk number, 464-4115, at the Information Management and Technology Department.

Will ICD-10-PCS replace CPT®?

No. ICD-10-PCS will be used to report hospital inpatient procedures only. The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) will continue to be used to report services and procedures in outpatient and office settings.

Why is ICD-9 being replaced?

The ICD-9 code set is more than 30 years old and has become outdated. It is no longer considered usable for today's treatment, reporting and payment processes. It does not reflect advances in medical technology and knowledge, and its format limits the ability to expand the code set and add new codes.

The ICD-10 code set reflects advances in medicine and uses current medical terminology. The code format is expanded, which means that it has the ability to include greater detail within the code. The greater detail means that the code can provide more specific information about the diagnosis, such as whether a condition affects the right or left side of a patient or whether this is an initial or subsequent encounter. The ICD-10 code set is also more flexible for expansion and including new technologies and diagnoses.

Because it is a big change, health care providers, as well as medical coders, billing employees and others are likely to feel disruptions as the transition takes place and people learn the system.

When do I have to convert to ICD-10?

All services and discharges on or after the compliance date must be coded using the ICD-10 code set. The compliance date is Oct. 1. The necessary system and workflow changes need to be in place by the compliance date in order for you to send and receive the ICD-10 codes.

What if I'm not ready by the compliance deadline?

Any ICD-9 codes used in transactions for services or discharges on or after the compliance date will be rejected as non-compliant, and the transactions will not be processed. There would be disruptions in your transactions being processed and the receipt of payments.

Is Upstate's conversion to ICD-10 the same as at other hospitals?

Upstate University Hospital is committed to making the changeover as smooth as possible as the Oct. 1 deadline approaches. Upstate is in line with the vast majority (93 percent) of the nation's hospitals that report confidence in being able to meet the deadline, according to testimony before Congress by the American Hospital Association.