ICD-10: Frequently Asked Questions

Category: Uncategorized

Who will be making this transition to ICD-10?

The ICD-10 mandated transition date of October 1st, 2015 applies to all covered entities.  This includes Medicare, Medicaid, and all commercial insurances, but does NOT include Worker’s Compensation or Auto/No-Fault insurances.  While they are not required to make the transition, many WC and Auto insurances are planning to anyway.  Those that aren’t must be accounted for, so we recommend reaching out to those insurances with an option and verifying their decision.  With the most recent upgrade, TheraOffice has the capability of submitting ICD-9 or ICD-10 codes, so you will be covered on all insurances.


What is the 7th character of an ICD-10 code?

The 7th character of an ICD-10 code represents the phase of treatment that the patient is in with regards to that specific diagnosis code.  For all injuries except fractures, the 7th character is broken down into 3 options:A – Initial Encounter (Active Care)
D – Subsequent Encounter (After Care)

S – Sequela (Late Effect)

It is best to view this from the patient’s perspective.  So let’s assume I have torn my ACL.  The trip to the ER, the follow-up with a specialist, and the following surgery are all part of the active care for my injury and would therefore be coded with Initial Encounter.  The physical therapist I went to go see after the surgery was part of the routine healing / after care phase of treatment and would be coded Subsequent Encounter.  If during this after care, I sustained another injury as a result of my ACL tear, that new injury would be coded as a Sequela.


When should I be adding this 7th character?

With the ICD-10 upgrade, your TheraOffice database will come preloaded with every single billable ICD-10 code.  This includes all codes that have an available 7th character extension.  While using TheraOffice, knowing which codes require a 7th character is simply a matter of finding the most appropriate code and seeing if a 7th character is available as an option to pick from.


What is dual coding?

Dual coding is coding for both ICD-9 and ICD-10 in the same case.  While only one code-set should be included in your documentation and on your claims, it is encouraged that you dual code within the case information to prepare yourself for the transition date.  On October 1st, you will be unable to lock a note unless that case has been properly coded with ICD-10.  Dual-coding for the months leading up to this date will allow for a seamless transition for your entire staff.


What is the 1 year flexibility period announced by CMS?  Does this mean that ICD-10 is optional for the first year?

No.  Announced on July 6th, CMS and AMA came to an agreement that for the first year, CMS would not reject any claims for lack of specificity.“As state in the CMS’ Guidance, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the CID-10 diagnosis codes as long as the physician/practitioner used a valid code from the right family of codes.”In other words, for the first year, you have a leniency period with Medicare where your coding does not need to be perfect.  However, there is absolutely zero room for error with regards to submitting an ICD-9 code for a date of service after October 1st, 2015.  Claims after this date with an ICD-9 code will be denied every single time.