International Classification of Diseases, 10^th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the World Health Organization (WHO). It replaces the International Classification of Diseases, 9^th Revision (ICD-9) that was developed in the 1970s.

The codes are the foundation for documenting the patient’s state of health and the institutional procedures provided.

Included in the ICD-10 are:

• ICD-10 CM (Clinical Modification) clinical modification of WHO standards for diagnosis
• ICD-10 PCS (Inpatient Procedures) inpatient procedures developed and maintained by CMS (Center for Medicare and Medicaid Services).

Per the US Department of Health and Human Services (HHS), all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must switch to ICD-10.

There are several key differences between ICD-9 and ICD-10 including:

• The code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. (ICD-10 codes use alphanumeric characters in all positions, not just the first position, as in ICD-9.)
• ICD-10 allows for increased specificity, allowing more information to be conveyed in a code.
• ICD-10 terminology is more modern and consistent throughout the code set.
• ICD-10 codes are a combination of diagnoses and symptoms, so fewer codes need to be reported to completely describe a condition.
• Enhanced ICD-10 codes enable reporting of laterality (right vs. left) to designate which side of the body or limb is being evaluated.
• In reporting of obstetric diagnosis, the ICD-10 codes classify the patient by their trimester of pregnancy (not their episode of care).

ICD-10 is required 10/1/15, however, we are not denying for specificity, as long as ICD-10 code is valid and in the appropriate family of codes, Johns Hopkins Health Plans will accept it.

This is a decision each provider makes. Johns Hopkins Health Plans will comply with individual provider requests.

If we already accept 5010 compliant files, certification is not necessary. If we do not accept 5010 compliant files, please contact your Network Manager for specific details.

Johns Hopkins Health Plans will accept ICD-9 codes with dates of service prior to October 1, 2015, both electronically and on paper.

If you have specific questions about your ICD-10 transition, please contact your network manager. You can also contact the Provider Relations department at 888-895-4998 or 410-762-5385. General ICD-10 information can be found at www.cms.gov/ICD10.

Additional ICD-10 information can be found on the following websites:

• Center for Medicare & Medicaid Services (CMS) – www.cms.gov
• American Medical Association (AMA) – www.ama-assn.org
• American Health Information Management Association (AHIMA) – www.ahima.org
• American Academy of Professional Coding – www.aapc.com
• Maryland Department of Health – https://health.maryland.gov/Pages/Home.aspx
• Johns Hopkins Health Plans – www.hopkinshealthplans.org