Myth vs. Fact ICD-10-CM/PCS

on Wednesday, 26 June 2013. All News Items | Coding

The implementation date for ICD-10-CM/PCS is fast approaching and CMS is constantly sending information through the Medicare Learning Network in the form of fact sheets. Below are a few excerpts from an April 2013 fact sheet clarifying Myth vs. Fact in ICD-10.  


Companies such as Worker’s Compensation and auto insurance companies are non-covered entities, which means they are not covered by HIPAA, can choose not to use ICD-10-CM/PCS.



It is in the best interest of the non-covered entities to use ICD-10 because ICD-9 will no longer be maintained after implementation. The non-covered entities will receive increased detail and value using the new system. CMS will be working with the non-covered entities to promote the use of ICD-10.



Medicaid will not be required to update their systems to use ICD-10 codes.



There will be one official list of national medical code sets per HIPAA requirements. CMS will be working with Medicaid to make sure ICD-10 implemented timely.



ICD-10-CM/PCS was developed without clinical input.



Several specialty societies contributed their clinical knowledge to the development of ICD-10.



The GEMs were developed to provide assistance in coding medical records.



GEMSs were not developed to help with coding medical records; we have codebooks for that. Mapping links the concepts in the two code sets without considering the medical record information.


GEMs can be used to convert the following databases from ICD-9 to ICD-10:

  1. Payment systems;
  2. Payment and coverage edits;
  3. Risk adjustment logic;
  4. Quality measures; and
  5. Different research applications involving trend data.



ICD-10 will require unnecessary detailed medical documentation when implemented.



Assigning ICD-10 is based on documentation in the medical record. A study performed by the American Hospital Association and the American Health Information Management Association revealed the specific information in ICD-10 was already in the medical record documentation. This specific information was not needed for ICD-9 coding.


Click on the link below to read the complete fact sheet. 


Article by Anita Meyers

Anita Meyers, RHIT, CCS, AHIMA-approved ICD-10 Trainer is an Inpatient Coding Professional at Medical Management Plus, Inc. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP, Inc. team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus, Inc. You may contact Anita at  This email address is being protected from spambots. You need JavaScript enabled to view it..



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