Countdown to ICD-10 - Top 10 Things to Do to Prepare for ICD-10

Sep 30, 2026

Uploaded by Stanley

Countdown to ICD-10 presents a structured preparation guide focused on understanding ICD-10, clarifying responsibilities, and executing a practical transition plan. It explains the federal mandate under HIPAA regulations, key changes between ICD-9 and ICD-10-CM/PCS code sets, and the compliance timeline with October 1, 2015 rules for claim acceptance. It then outlines top action areas including system checks, staff training, resource building, testing cycles, and maintaining ongoing awareness, supported by ICD-10 FAQs and related resources.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

ICD-10 Overview

Federal mandate under HIPAA

ICD-10 code sets and replacement scope

Compliance date and claim rules

Why ICD-10 matters

Top Ten Things to Do to Prepare for ICD-10

Get to know ICD-10

Know your role and responsibility

Follow your roadmap

Conduct systems checks

Welcome to Countdown to ICD-10: TOP 10 THINGS TO DO TO PREPARE FOR ICD-10 Topics for Discussion Countdown to ICD-10 􀂃 ICD-10 Overview 􀂃 Top 10 Things to Do to Prepare for ICD- 10 􀂃 Get to Know ICD-10 􀂃 Know Your Role and Responsibility 􀂃 Follow Your Roadmap 􀂃 Conduct Systems Checks 􀂃 Train Your Brain 􀂃 Practice Makes Perfect 􀂃 Build Your Resources 􀂃 Testing…Testing…Testing 􀂃 Patience & Patients 􀂃 Stay Informed 􀂃 ICD-10 FAQs 􀂃 Resources 􀂃 Contact 1 ICD-10 Overview 􀂃 Federal Mandate under Health Insurance Portability and Accountability Act (HIPAA) Regulations 􀂃 ICD-10 mandatory for all HIPAA-covered entities 􀂃 Entities include: hospitals, physicians and other practitioners, health insurers, 3 rd party payers, electronic transmission firms, clearinghouses, hardware/software vendors, billing practice and management firms, health care administrative and oversight agencies, public and private health care research institutions 􀂃 New ICD-10-CM and ICD-10-PCS code sets 􀂃 ICD-10-CM replaces ICD-9-CM (Volumes 1 and 2) 􀂃 ICD-10-PCS replaces ICD-9-CM (Volume 3) 􀂃 ICD-10 has no direct impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) ICD-10 is coming! 2 ICD-10 Overview A few facts about ICD-10: 􀂃 World Health Organization-developed ICD-10 in 1994, later adopted by HHS and CDC, provision of HIPAA regulations 􀂃 Moving from 9 to 10-US is last industrialized nation to adopt ICD-10 􀂃 HIPAA-covered entities-health care providers, payers, clearinghouses, billing services and others must transition to ICD-10 􀂃 ICD-10 pros and cons-discussed widely within health care community since 2009 􀂃 ICD-10-CM and ICD-10-PCS code sets 􀂃 Replaces ICD-9-CM (Volumes 1 and 2) and ICD-9-CM (Volume 3) 􀂃 Total of 141,923 codes BUT only some used by providers 􀂃 Mandatory compliance date-October 1, 2015 􀂃 Reminder 5010 transaction standards, required prerequisite 􀂃 IT systems must accommodate BOTH ICD-9 and ICD-10 codes ICD-10 Overview 􀂃 For services rendered on or after October 1, 2015 􀂃 All claims must use ICD-10 codes 􀂃 Claims using ICD-9 codes for services rendered on or after October 1, 2015 will NOT be accepted 􀂃 For services rendered before October 1, 2015 􀂃 All claims must use ICD-9 codes 􀂃 Systems must accommodate BOTH ICD-9 and ICD-10 codes 􀂃 Effective with the October 1, 2015 compliance date 􀂃 Significant Code Increase from ICD-9 to ICD-10 􀂃 Increasing from 14,000 to approximately 69,000 ICD-10-CM codes 􀂃 Increasing from 3,000 to approximately 87,000 ICD-10-PCS codes 􀂃 ICD-10 has more than nine times the codes in ICD-9 4 ICD-10 Overview Why ICD-10 Matters: 􀂃 ICD-10 advances health care and the implementation of eHealth initiatives 􀂃 ICD-10 captures advances in medicine and medical technology 􀂃 ICD-10 improves data for quality reporting 􀂃 ICD-10 improves public health research, reporting and surveillance Top Ten Things to Do to Prepare for ICD-10 1. Get to Know ICD-10 􀂃 Understanding background information makes transitioning easier 􀂃 Acknowledge the necessity for ICD-10 􀂃 Recognize the risks of non-compliance 􀂃 Recognize the benefits that come with transitioning and compliance 􀂃 Learn the differences between ICD-9 versus ICD-10 􀂃 Learn who needs to transition to ICD-10 Top Ten Things to Do to Prepare for ICD-10 2. Know Your Role & Responsibility 􀂃 Everyone in your organization has a part in the transition 􀂃 ICD-10 Champion 􀂃 Coders 􀂃 Billers 􀂃 Clinicians 􀂃 Practice Managers 􀂃 IT Systems Managers IT Managers Coders Champion Organization Practice Managers Clinicians Billers Top Ten Things to Do to Prepare for ICD-10 3. Follow Your Roadmap 􀂃 Execute your plan 􀂃 Perform an office assessment 􀂃 Utilize your ICD-10 Roadmap 􀂃 Distribute collateral material (organization updates, newsletters) 􀂃 Establish lines of external communication

FAQs

What is the HIPAA-related requirement for ICD-10 adoption?

ICD-10 is mandatory for all HIPAA-covered entities. These include hospitals, physicians and other practitioners, health insurers, third-party payers, clearinghouses, and related billing and IT organizations.

When must healthcare systems use ICD-10 codes, and what happens if ICD-9 codes are used after that date?

For services rendered on or after October 1, 2015, all claims must use ICD-10 codes. Claims using ICD-9 codes for services rendered on or after October 1, 2015 will not be accepted.

What are the main preparation steps recommended in the Top Ten list?

The document recommends getting to know ICD-10, defining role and responsibilities, following a roadmap, and conducting systems checks, with additional emphasis on training, testing, building resources, and staying informed.

Sep 30, 2026

Uploaded by Stanley