Be ICD-10 Ready. Now. 

The healthcare industry is transitioning from ICD-9 diagnosis codes to the ICD-10 system on October 1, 2015.

As a healthcare professional, you understand that medical laboratories are required to submit accurate and complete diagnosis codes when submitting claims to all third party payers. The ICD-10 code change requires greater specificity when coding patient visits. It is imperative that the most specific ICD-10 code is provided to avoid triggering follow-up inquiries that unfortunately utilize the provider’s and lab’s resources to resolve coding issues.

CMS Overview and Quick Reference Information

Information and guidance for the new ICD-10 diagnosis coding can be found on the following websites:

General ICD-10 information:

Code Converter (ICD-9 to ICD-10 and ICD-10 to ICD-9):

ICD-10-CM files, information, and general equivalence mappings between ICD-10 and ICD-9:

Classification of Diseases, Functioning, and Disability:

Frequently Asked Questions regarding ICD-10

What is ICD-10?
ICD-10 is a code system of diseases, signs, symptoms, abnormal findings, and complaints. It replaces ICD-9 codes. ICD-10 is a more robust coding system, needed to accurately describe health diagnoses and procedures with the level of detail needed for quality improvement and reimbursement. This level of detail enhances precision in the identification of diagnoses and procedures. ICD-10 is a federal mandate; it is NOT limited to Medicare.

What is the implementation date for transitioning to ICD-10?
Please be advised that October 1, 2015 is the compliance date established by the Centers for Medicare and Medicaid Services (CMS) for health care providers to transition to the new ICD-10 code system. The October 1, 2015 date is FIRM. Claims for services provided on or after October 1, 2015, MUST use ICD-10 codes. Claims for services provided prior to October 1, 2015 MUST use ICD-9 codes. There is NO grace period.

Can SpectraCell enter ICD-10 codes on my behalf if I am unable to transition by October 1, 2015? SpectraCell Laboratories is not allowed to provide a safety net for providers for ICD-10. All providers must understand what needs to be included in their documentation so that ICD-10 codes are correctly assigned.

What if I fail to transition to ICD-10 codes?

If a claim is filed without an ICD-10 code(s), it will be rejected, and providers will not get paid for their services.

Can I submit a claim with both ICD-9 and ICD-10 codes?
No - only one code set can be accepted per claim. You are encouraged to review past documentation to see what you will need to update to ICD-10, as you will likely need only a small subset of codes.

Will I need to submit an ABN?
Yes – when a lab test is not covered according to Medicare’s medical necessity criteria.