CMS Transition to ICD-10

Irving, Texas – For services provided on or after October 1, 2014 the ICD-9 code sets will be replaced by ICD-10 code sets. The Central offices for Medicare and Medicaid services (CMS) use these code sets to report medical diagnoses and inpatient procedures. The transition is required for everyone covered by the Health Insurance Portability Accountability Act (HIPPA).

ICD-9 code set procedures is about 30 years old, inconsistent, and limits data about patients’ medical conditions and hospital inpatient procedures. Therefore, the transition to ICD-10 code set procedures will allow exact specification and classification of patient’s diagnosis. It will accommodate new diagnoses, procedures, and improve billing performance and fraud detection.

The ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

1. ICD-10-CM is for use in all U.S. health care settings and uses three to seven digits instead of the three to five digits used with ICD-9-CM. Formats of the ICD-10-CM code set is similar to ICD-9CM code set. 2. ICD-10-PCS is for use in U.S. inpatient hospital settings only. It uses seven alphanumeric digits instead of the three to four numeric digits used under ICD-9-PCS procedure coding and is more specific.

Throughout the course of the transition CMS will continue to add tools, information, and updates. For FAQ and more information about ICD-10 transition code sets visit www.cms.gov/ICD10.

The information provided is only intended to be a general summary and is not intended to take place of either the written law or regulations. We encourage our readers to review the specific regulations.