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Frequently Asked Questions
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What is ICD-10?
International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the World Health Organization (WHO). It replaces the International Classification of Diseases, 9th Revision (ICD-9) that was developed in the 1970s.
The codes are the foundation for documenting the patient’s state of health and the institutional procedures provided.
Included in the ICD-10 are:
- ICD-10 CM (Clinical Modification) clinical modification of WHO standards for diagnosis
- ICD-10 PCS (Inpatient Procedures) inpatient procedures developed and maintained by CMS (Center for Medicare and Medicaid Services).
Who must comply with ICD-10?
Per the US Department of Health and Human Services (HHS), all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must switch to ICD-10.
What are some of the differences between ICD-9 and ICD-10?
There are several key differences between ICD-9 and ICD-10 including:
- The code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. (ICD-10 codes use alphanumeric characters in all positions, not just the first position, as in ICD-9.)
- ICD-10 allows for increased specificity, allowing more information to be conveyed in a code.
- ICD-10 terminology is more modern and consistent throughout the code set.
- ICD-10 codes are a combination of diagnoses and symptoms, so fewer codes need to be reported to completely describe a condition.
- Enhanced ICD-10 codes enable reporting of laterality (right vs. left) to designate which side of the body or limb is being evaluated.
- In reporting of obstetric diagnosis, the ICD-10 codes classify the patient by their trimester of pregnancy (not their episode of care).
Will JHHC deny physician or other practitioner claims billed under Part B based on specificity of ICD-10 diagnosis code as long as the code is from the same family?
ICD-10 is required 10/1/15, however, we are not denying for specificity, as long as ICD-10 code is valid and in the appropriate family of codes, JHHC will accept it.
Will JHHC return 835s for providers to review results?
This is a decision each provider makes. JHHC will comply with individual provider requests.
Will JHHC require providers, clearinghouses, etc. to be certified in order to send ICD-10 claims?
If we already accept 5010 compliant files, certification is not necessary. If we do not accept 5010 compliant files, please contact your Network Manager for specific details.
How will JHHC handle ICD-9 codes?
JHHC will accept ICD-9 codes with dates of service prior to October 1, 2015, both electronically and on paper.
Does JHHC have an ICD-10 provider liaison?
If you have specific questions about your ICD-10 transition, please contact your network manager. You can also contact the Provider Relations department at 888-895-4998 or 410-762-5385. General ICD-10 information can be found at www.cms.gov/ICD10.
Where can I get more information about ICD-10?
Additional ICD-10 information can be found on the following websites:
- Center for Medicare & Medicaid Services (CMS) – www.cms.gov
- American Medical Association (AMA) – www.ama-assn.org
- American Health Information Management Association (AHIMA) – www.ahima.org
- American Academy of Professional Coding – www.aapc.com
- Maryland Department of Health and Mental Hygiene – http://dhmh.maryland.gov/SitePages/Home.aspx
- Johns Hopkins HealthCare – www.jhhc.com