Practicing Medicine Business of Medicine ICD-10 FAQs


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Frequently Asked Questions

Get the latest updates on how to make sure your practice is in ICD-10 compliance.

ICD-10 is the latest revision of the World Health Organization’s medical classification list containing nearly 70,000 diagnosis codes for diseases, signs and symptoms, complaints, abnormal findings and external causes of injury or disease. Check out our list of FAQs to make sure you’re up to date on the most recent developments.

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Who has to use ICD-10 codes?

All health plans, clearinghouses, and providers who do electronic transactions must use ICD-10 codes to indicate diagnoses. Health plans are expected to require ICD-10 codes on paper transactions also. Note that workers’ compensation plans, auto insurance, and property and casualty plans are not subject to this federal requirement. Their requirements are set by each state. Some states are already requiring ICD-10 codes for these plans, while others are not.

If I don’t see Medicare patients, do I have to use ICD-10 codes?

Everyone covered by HIPAA must use ICD-10.

Do ICD-10 codes replace CPT procedure codes?

No. ICD-10 does not affect CPT coding for outpatient procedures. ICD-10 provides diagnosis codes.

Do I have to learn the whole code set?

No. You only need to understand that codes that are relevant to your practice. The ICD-10 code set is well organized so that your relevant codes are easy to find.

Where can I find the ICD-10 codes?

The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge on the CMS website.

Where are the somatic dysfunction codes located in ICD-10?

The codes for somatic dysfunction are located in Chapter 13; Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99).

What types of things will I need to include in my documentation?

You will need to include details such as laterality, severity, stage and specific type and order.  For specific conditions, requirements will vary; some examples for common conditions in family medicine include:

  • Asthma: intermittent, mild persistent, moderate persistent, severe persistent

  • Fractures: Gustilo classification, type of fracture

  • Seizures: General or focal, what type, intractability

  • Pregnancy: Which trimester

  • Poisoning or toxic effect: Which substance

  • Ulcers: Which stage

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