ICD-10 Resources

If you’re looking for ICD-10 education, you’ve come to the right place! Below are resources that will help you increase your familiarity and comfort with ICD-10 coding.

Update on the specificity “grace period”

CMS has confirmed the end of the one-year “grace period” for ICD-10 claims.  For the first year that ICD-10 was in place (October 1, 2015 – October 1, 2016), CMS did not deny claims solely for lack of coding specificity. However, as of October 1, 2016, CMS will no longer “give a pass” for diagnosis codes that are not as specific as the claim documentation supports. Unspecified codes may be used in claims after October 1, but only in cases when the medical record does not provide enough detail to accurately assign a more specific code. As of October 1, both CMS and commercial payers will expect providers to use the most specific diagnosis code(s) that the medical record and the provider’s familiarity with the patient’s condition will support. See the updated ICD-10 Guidance for more information.

Resources for Change

Code USA Documentation Assessment

  • Most offices need to alter their documentation processes to support ICD-10, and this can be the longest, most involved part of their preparation. A documentation assessment will show you how far you have to go, allowing you to plan accordingly.
  • Suitable for: All practices
  • How to get started: Visit the website
Training

CMS Key ICD-10 Coding Basics (On-Demand Video)

  • This new CMS video, “ICD-10 Post-Implementation: Coding Basics Revisited,” discusses topics like:
    • What is a valid code?
    • Guidelines for coding and reporting
    • Coding processes and examples: 7th character, unspecified codes, external cause codes, laterality
    • How to submit coding questions
    • Resources for Coders
  • Suitable for: Billers and coders
  • CEU/CME Available? No
  • How to get started: View the video
Formal Education

Weber State University

  • Suitable for: Anyone wanting to become a certified coder
  • How to get started: Visit the website
Standard, FAQ, and Published Resources

CMS

Code Books and Lookup Tools

Code Books

Code books may be purchased from a number of websites, including:

The code books available for purchase have been formatted by the publishers to be useful, easy to navigate, and include extra tips. But what if you can’t get approval to buy a book? You can get the basic code set from CMS for free (both CM, which is for most outpatient services, and PCS, which is used more in inpatient settings).

Free GEM-Based Mapper

  • Health Data Consulting has graciously made their easy GEM based mapping tool available for free. They say on their press release: “This tool is based on the CMS published 2014 GEM (General Equivalency Mapping) files for ICD-9 diagnosis and ICD-10-CM codes. It is helpful in identifying sets of codes in ICD-10 that are included in the GEM mapping files. GEM mapping does not consistently identify all of the codes that would meet the intent that the user initially had in an existing ICD-9 set and it may bring over codes that do not meet that initial intent as defined in ICD-9. It is however a valuable help in starting the mapping process.”
  • For more information and the link to the tool, see the HDC website.

Free ICD-10 Reference Websites

  • ICD10Data.com is a free reference website that contains all of the official American ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) medical billing codes. Use this site to search for any code, and to discover how the structure of the new coding set works. The website is http://www.icd10data.com/
  • NueMD, a software company for provider offices and billing services, offers a free online ICD-10 code lookup tool. The tool is available at http://www.nuemd.com/icd-10/codes.