Have you started your countdown clocks yet? It looks like it’s definitely happening this year on Oct. 1, 2014. The transitions from ICD-9 to ICD-10 coding will 100% absolutely take effect for the entire healthcare system, including therapy. So what is this big change all about? Per CMS, there are a couple of key facts everyone should be preparing for.

1.     ICD-10 compliance means that a HIPAA-covered entity uses ICD-10 codes for healthcare services provided on or after Oct. 1, 2014. ICD-9 diagnosis and inpatient procedure codes CANNOT be used for services provided on or after this date.

2.     The transition to ICD-10 does NOT affect CPT coding for billing purposes. Like ICD-9 procedure codes, CPT coding will continue to be used in conjunction with the ICD-coding.

3.     Even if you don’t directly bill to Medicare, you are still required to change to the ICD-10 coding system. This includes Medicaid, private insurance and anytime or place you currently use ICD-9 coding.

4.     Timing is everything. You CANNOT transition early and must follow the October 1, 2014, implementation/compliance dates.  Testing claims and other types of quality reporting are allowed, but submitting claims for actual reimbursement must follow the set timelines.

5.     Healthcare providers should be talking to their software vendors and billing departments to discuss the readiness plans, milestone timelines for testing and implementation, availability, and training.

The ICD-10 codes give healthcare providers greater specificity and exactness in describing a patient’s diagnosis and in classifying inpatient procedures. The new coding system also will accommodate newly developed diagnoses and procedures, innovation in technology and treatment, performance-based payment systems, and more accurate billing. ICD-10 coding will make the billing process more streamlined and efficient, and this will allow for more precise methods of detecting fraud.

To view more of the training material issued by CMS, please click here. The information shared with this blog is from the ICD-10 FAQS which are located at this website.

As therapists, we are often overwhelmed with changes of this magnitude. But if we can start the planning stages, we can target April 1, 2014, as the six-month marker, and hopefully enjoy a successful transition phase.


Shelly Mesure (“measure”), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.