The ICD-10 code set replaced the ICD-9 code set on October 1, 2015. Claims submitted using ICD-9 codes after this date will be rejected. In July 2015, the Centers for Medicare and Medicaid Services (CMS) announced that it will allow a certain degree of leniency in submitting ICD-10 codes during the first year of implementation. As long as an ICD-10 code is submitted using a valid code from the correct family, the ICD-10 claim will not be denied, even if it is not coded to the highest level of specificity. Medicare Administrative Contractors, Recovery Audit Contractors, Zone Program Integrity Contractors and Supplemental Medical Review Contractors will adhere to this policy.
CMS will apply the same specificity standard to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM) and Meaningful Use (MU) programs for program year 2015. Medicare clinical quality data review contractors will not penalize physicians or other Eligible Professionals (EPs) as long as they submit the ICD-10 code from the correct family of codes. CMS also created an ICD-10 Ombudsman that will work as a liaison between physicians and CMS’ regional offices. For more information on these policies, visit the CMS website.
The transition to ICD-10-CM does not affect CPT® coding for outpatient procedures and physician services. These services should continue to be reported using CPT and Healthcare Procedure Coding System (HCPCS) codes.
The ICD-10 code set varies significantly from ICD-9. The chart below provides a snapshot of the differences between the two code sets. The Basics of the ICD-10 Code Set.
Comparison: ICD-9 versus ICD-10
Number of codes
Code structure – Length
Code structure – Type of Digits
Digit 1 – alpha or numeric
Digits 2-5 – numeric
Digit 1 – alpha
Digits 2-3 – numeric
Digits 4-7 – alpha or numeric
Capacity to add codes
Limited space for adding new codes
Space for adding new codes
Level of detail
Has laterality (i.e., right vs. left)
ICD-10-CM disease classification includes significantly more health-related conditions and greater specificity. The following revisions are new to ICD-10-CM:
A Closer Look at Neoplasm Diagnostic Codes
While the transition to ICD-10 is a significant change, ASTRO’s review of the neoplasm diagnostic codes suggests that the transition from ICD-9 to ICD-10 appears to be relatively straightforward for our subset of codes. The chart below provides some example mappings from ICD-9 to ICD-10 relevant to radiation oncology.
Malignant neoplasm of liver, primary
Other specified carcinomas of liver
Malignant neoplasm of liver, primary, unspecified as to type
Malignant neoplasm of trachea
Malignant melanoma of skin of eyelid, including canthus
Melanoma in situ of eyelid, including canthus, unspecified side
Melanoma in situ of right eyelid, including canthus
Melanoma in situ of left eyelid, including canthus
Malignant melanoma of eyelid, including canthus, unspecified side
Malignant melanoma of right eyelid, including canthus
Malignant melanoma of left eyelid, including canthus
Malignant neoplasm of prostate