ICD-10 Transition Update

August 3, 2015
Rick Gawenda

With the transition to ICD-10 less than 2 months away, providers still have questions concerning ICD-10 and how to use the codes in their outpatient therapy practice and/or department. Worse yet, some providers have yet to start their ICD-10 training and education as they were hoping for a delay in the implementation date. For those that waited, start your training and education now. The Centers for Medicare and Medicaid Services (CMS) has no plans to delay the implementation date and you must be ready to begin using ICD-10 codes for dates of service on or after October 1, 2015.

To help you prepare, CMS has a webpage dedicated to ICD-10 with lots of information available to practices, organizations, billing companies, and clearinghouses. In addition, CMS has been publishing weekly bulletins to assist providers in preparing for the October 1, 2015 implementation date.

In their most recent publication, CMS discussed the following topics concerning ICD-10:

  • List of Valid ICD-10-CM Codes
  • Use of Unspecified Codes in ICD-10-CM
  • Transition of ICD-10 for Home Health
  • Claims that Span the ICD-10 Implementation Date
  • Coding for ICD-10-CM Regarding Laterality
  • Questions and Answers Regarding ICD-10 Coding Flexibilities

Over the next 2 months, Gawenda Seminars and Consulting (GSC) will be providing webinars on ICD-10 for outpatient physical, occupational and speech therapy services related to pediatrics, adults, and geriatrics covering a wide range of conditions and diagnoses’. GSC will also be publishing questions and answers concerning ICD-10 on our ICD-10 FAQ page that is available to our Gold Members. Questions that Rick has answered that are available right now to our Gold Members are:

  • What is the implementation date for ICD-10?
  • Will all insurances mandate we report ICD-10 codes instead of ICD-9 codes?
  • After the implementation of ICD-10, is it possible that we could use ICD-10 codes with some insurance carriers and ICD-9 codes with other insurance carriers?
  • What are benefits of switching to ICD-10-CM for outpatient therapy services?
  • What is the difference between ICD-10-CM and ICD-10-PCS?

To view the most recent CMS Publication on ICD-10 implementation and to gain access to the answers for the above 5 questions, click

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. With some auto no-fault insurance carriers and workers compensation that are not HIPAA covered entities and are not required to transition to ICD-10 on October 1, 2015 how would you recommend we find this out as majority of computer systems will be set to use only the ICD-10 codes as of October 1st? Can they deny the claim if ICD10 is used versus ICD9. Just thinking this may be very hard to switch back and forth between ICD10 and ICD9 based on insurance, and not sure that the computer software will allow this after October 1st.

    1. You will have to check with each auto no-fault and workers compensation carrier that you submit claims to. If they do not transition to ICD-10, then you must continue to sue ICD-9 codes for those claims.

  2. How can I find out what Medicare is expecting on the medical diagnosis of patients we will continue when we switch to ICD-10 October 1, 2015? Are we expected to get new prescriptions from Physicians with the updated ICD-10 codes or are we as therapist expected to determine a new ICD-10 based on the original prescription?