ICD-10 Quick Start Guide

This guide outlines 5 steps health care professionals should take to prepare for ICD-10 by the October 1, 2015 compliance date. You can complete parts of different steps at the same time if that works best for your practice.

You must use:

ICD-10 codes for all services provided on or after October 1 ICD-9 codes for all services provided before October 1
Crucial activity = Crucial activity
Step 1Make a Plan
Assign target dates for completing steps outlined here
Obtain access to ICD-10 codes. The codes are available from many sources and in many formats:
  • Code books
  • CD/DVD and other digital media
  • Online (e.g., go to cms.gov/ICD10 and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
  • Practice management systems
  • Electronic health record (EHR) products
  • Smartphone apps
Decide role(s) your clearinghouse(s) will play in your transition. Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims:
  • Clearinghouses can help by:
    • Identifying problems that lead to claims being rejected
    • Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)
  • Clearinghouses cannot help you code in ICD-10 unless they offer third-party billing/ coding services
Step 2Train Your Staff
Train staff on ICD-10 fundamentals using the wealth of free resources from CMS, which include the ICD-10 website, Road to 10, E-mail Uupdates, National Provider Calls, and webinars. Free resources are also available from:
  • Medical societies, health care professionalassociations
  • Hospitals, health systems, health plans,vendors
Identify top codes. What ICD-9 diagnosis codes does your practice see most often? Target the top 25 to start. You might want to look at common diagnosis codes available from:
Using the documentation available, code current cases in ICD-10. Flag any cases where moredocumentation is needed.
Step 3Update Your Processes
Update hard-copy and electronic forms (e.g., superbills, CMS 1500 forms)
Resolve any documentation gaps identified while coding top diagnoses in ICD-10
Make sure clinical documentation captures key new coding concepts:
  • Laterality—or left versus right
  • Initial or subsequent encounter for injuries
  • Trimester of pregnancy
  • Details about diabetes and related complications
  • Types of fractures
Step 4Talk to Your Vendors and Health Plans
Call your vendors to confirm the ICD-10 readiness of your practice’s systems
Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
Step 5Try Your Systems and Processes
Try using your ICD-10-ready systems to:
  • Generate a claim
  • Perform eligibility and benefits verification
  • Schedule an office visit
  • Schedule an outpatient procedure
  • Prepare to submit quality data
  • Update a patient’s history and problems
  • Code a patient encounter
If your systems are not ready, use alternate ways to submit ICD-10 claims.

For Medicare providers, options include:

Ask other health plans you work with about the options they offer.