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International Classification of Diseases, 10th Edition (ICD-10)

What is ICD-10? 

ICD-10 stands for the International Classification of Diseases, 10th Edition, that details a resident’s conditions or diagnoses. On October 1, 2015, all Health Insurance Portability and Accountability Act (HIPAA)-covered entities (including all nursing and assisted living centers) were required to stop using the International Classification of Diseases, 9th Edition (ICD-9), and transition to using ICD-10, in order to get reimbursed.

Why is implementation challenging for nursing and assisted living centers?

Implementation is challenging for health care provider staff because they must learn new ICD-10 coding (which is significantly different from ICD-9 coding) to ensure appropriate billing and reimbursement. This will require leadership (either at the facility or corporate office levels) to train the staff responsible for implementing rules and regulations for proper coding. At different intervals (resident discharge, transfer or expiration), staff are required to reevaluate and update ICD-10 codes (particularly for long-stay residents).  All diagnoses that affect the residents care must be coded appropriately. Centers also should consider that in an era of heightened focus on fraud and abuse, federal regulators may in the future look more closely at ensuring that the ICD-10 coding on claims and assessments (e.g., MDS).

AHCA/NCAL Resources:

         AHCA ICD-10 FAQs (developed from member questions submitted to

         CMS Response to AHCA Letter on ICD-10 Codes 

         Publications, all of which can be found at AHCA/NCAL bookstore using a search for “ICD-10”

o   ICD-10-CM 2014 Edition

o   ICD-10 Essentials for Long- Term Care: Your Guide to Preparation and Implementation

o   ICD-10 Coding for Long-Term Care

CMS Resources:

         CMS ICD-10 Overview, which include the following key documents:

o   CMS Blog

o   CMS Resource Guide and Contact List

o   CMS Medicare Fee-for-Service FAQs