ICD means International Classification of Diseases.
ICD contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
ICD is maintained and updated by the World Health Organization (WHO).
Affects everyone covered by HIPAA, not just those submitting Medicare or Medicaid claims.
ICD codes were originally created for purpose of compiling mortality statistics.
Dental Implications:
Dental CDT codes tell what procedure was done. ICD-10 codes tell why it was done.
Dental providers will continue to use CDT codes for reporting procedures on dental claims.
The 2012 ADA Dental Claim Form has four blocks where practitioners can report ICD-10-CM diagnosis codes (see graphic below).
ICD-10-CM codes can be used on both dental and medical claim forms.
Most of the ICD-10 codes that apply to dentistry are on Chapter 11, Diseases of the Digestive System (K00-K95).
More and more states are requiring ICD-10-CM codes on Medicaid claims, and will reject dental claims that don't include the ICD code. The reason for rejection might not be clear that it was because of a missing ICD code. ICD codes are also required by some private third-party payors and ACA plans.
ICD codes can facilitate claims related to oral-systemic connection.
Where to enter the ICD-10 code on the dental claim form:
Different ICD Code Sets:
ICD-10-CM
It is a US national variant of the ICD, developed by CDCP in conjunction with NCHS.
Intended for clinical and outpatient medical coding and reporting.
Useful for physicians, dentists, and other health care providers.
Contains diagnostic codes.
Used in US since October 1, 2015.
CM stands for Clinical Modification
ICD-10-PCS
It is a US national variant of the ICD, developed by CDCP in conjunction with NCHS.
It contains procedure codes.
It is intended for inpatient hospital settings.
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