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For Providers > ICD-10

For Providers - ICD-10

Effective October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. ICD-10 will affect diagnosis and inpatient procedure coding for all providers covered by the Health Insurance Portability & Accountability Act (HIPAA). The transition to ICD-10 is occurring because ICD-9 produces limited data about patient"s medical conditions and hospital inpatient procedures. In addition, ICD-9 is limited in the number of new codes that can be created, uses outdated terms and is inconsistent with current medical practice.

To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010. The following are the timelines for this conversion:

By December 31, 2011 - all external testing of Version 5010 for electronic claims submissions must be complete in order to be compliant.
On or after January 1, 2012 - all electronic claims must use Version 5010 as Version 4010 will no longer be accepted.
By October 1, 2013 - all claims for dates of service on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures; CPT codes will continue to be used for outpatient services.

In an effort to assist providers billing for services rendered to CenCal Health members, we are making available a tool for converting ICD-9 codes to ICD-10 codes. The ICD-10 code online translator tool, developed by the American Association of Professional Coders (AAPC), allows you to compare ICD-9 to ICD-10 codes as ICD-9 is being expanded from 17,000 to approximately 141,000 ICD-10 codes. This online tool can help you map that expansion.

Please note: the online translator tool only converts ICD-10-CM codes, not ICD-10-PCS for inpatient coding. In addition, verification through this tool does not validate Medi-Cal billing guidelines used by CenCal Health in order to process claims and thus does not guarantee claims payment.

For more information on the ICD-10 and Version 5010 conversion, please visit the Centers for Medicare & Medicaid Services? (CMS) website at www.cms.gov/ICD10.