An Essential Guide To ICD-10: All You Need to Know

 ICD-10 refers to the medical coding system that was made by WHO (World Health Organization) in order to categorize all of the health conditions that are similar to one another and also where all of the conditions are listed in a proper manner. These help in having a more nuanced definition for each of the diseases and specifying them under different morbidity levels. The majority of the countries have different variations of the ICD-10 medical coding that suits that particular country’s health infrastructure. 

What Is ICD-10?

ICD-10-PCS stands for the International Classification of Diseases, Tenth Revision, Procedure Coding System.

When one refers to ICD-10 codes it means the tenth international classification of the diseases. As the name suggests it is a general classification of all the medical codes that are present out there. The ICD-10 implementation is quite widespread since all of the hospitals make use of it when it comes to reporting inpatient procedures.  

The U.S medical industry makes use of the ICD codes when they report all of the healthcare settings. Moreover, the standard classification when it comes to medical codes represents all of the diseases and conditions that are connected to abnormal findings, injuries, causes for the diseases and injuries, symptoms and signs along with all the social circumstances that could have caused it. 

For any medical provider to get the proper reimbursement for all the services that they have provided, it is important to focus on the ICD-10-CM codes because without that the payer will not approve the submitted claims. It is the proper ICD-10 codes that help in depicting the proper diagnosis of the patient and also justify all of the medical services that have been rendered by the medical organization to the patients. 

What Is the Importance Of ICD-10?

The U.S. developed a Clinical Modification (ICD-10-CM) for medical diagnoses based on WHO's ICD-10 and CMS developed a new Procedure Coding System

With the change in ICD-10 guidelines taking over the medical world it is only natural to learn about ICD-10 codes and why is it so important in modern times.

1. ICD-10 will be a replacement for ICD-9

With the introduction of ICD-10, medical billers and coders no longer have to refer to ICD-9 instead they will put their sole focus on ICD-10. ICD–9 consists of three to five characters having a decimal point each. The International Classification of Diseases that are present in ICD-10 makes use of three to seven characters in a combination that consists of alpha-numeric characters. Along with a different medical code structure, ICD-10 codes will have five times the number of codes that were present in ICD-9. This will make sure that the specification is absolutely proper without any room for error.

2. Change is important

Among all the countries that have adopted ICD 10 codes, the U.S healthcare industry has been one of the last countries to adopt the medical codes. There are several different reasons why the change is a necessity in the modern medical world;

– The US medical industry is inconsistent and outdated when it comes to the terms. The ICD-9 has been there for many years which is why the transition must take place to ICD-10.

– ICD-10 has five times the number of medical codes that there were in ICD-9 therefore using the latter gave limited data about the condition of the patients.

– The creation of newer codes gets limited and the majority of the categories under the ICD-9 are already full. 

3. Change is imperative

A document from CMS ICD 10 said that all of the medical claims for the inpatient procedures and medical services that have been performed on October 1, 2014, or after must make use of the ICD-10 medical diagnosis along with the proper inpatient medical codes. Medical claims that do not make proper use of the ICD-10 codes along with the procedure codes will not go through the claims processing procedure. Therefore, it will only make the situation worse since the reimbursement will be harder to acquire.

4. ICD-10 will go into effect from October 1, 2014

Since ICD-10 will go into effect from the 1st of October, 2014 it is important to note that all of the medical services before October 1st will make use of the ICD-9 codes. The ICD-10 implementation procedure will therefore start from October 1st.

5. ICD-10 will not be a replacement for the CPT codes

Specific ICD-10 codes for Dravet syndrome went into effect on October 1, 2020 (FY2021).

ICD-10 codes are referred to as diagnostic codes, whereas CPT codes are referred to as billing codes. Even when both of them are necessary for the preparation of medical claims, it is important to understand that ICD-10 will not be a valid substitute for CPT codes for outpatients since both of them are completely different. Similar to the ICD-9 codes, ICD-10 PCS codes are present for the inpatient procedures alone. 

6. ICD-10 will affect you

Whenever any hospital or medical organization is covered under HIPAA it is important to note that ICD-10 will affect them and not just those who submit their Medicaid or Medicare claims. Therefore, ICD-10 will affect the payers, medical providers, billing services and clearinghouses as well. In a summarized manner, if any individual is under the umbrella of HIPAA, they would have to make the transition toward ICD-10.

7. Preparation is needed

  1. It is important to prepare yourself for the change from ICD-9 to ICD-10. There are over 68,000 diagnostic codes under ICD-10 which is why these are the things that you should follow to make the transition a little bit easier:

    – Make sure to develop a proper implementation strategy. Assess all of the impacts that ICD-10 will bring about in the organization. Develop a proper timeline to work out the details and have an allocated budget.

    – Check with the medical billing services, the clearinghouse and with all of the vendors about how the process of implementation is going to take place. If the process of medical billing is being handled internally, the process of coding, finance and IT staff, and clinical staff should be involved with the planning procedure about how the transition is to be made.


The use of ICD-10 codes will bring about more specificity into the world of medical billing and coding allowing for better classification of diseases. In case you are looking to outsource medical billing to a capable company, Synergy HCLS can be an excellent choice.