ICD-10 Coding Guidelines 

CarePlus provides the following documents to assist coders in accurately coding and documenting diagnoses and services provided to CarePlus-covered patients: 

Atrial Fibrillation

Cardiomyopathy 

Cerebrovascular Accident

Chronic Kidney Disease

Chronic Obstructive Pulmonary Disease

Deep Vein Thrombosis

Diabetes Mellitus

Diseases of the Respiratory System

End Stage Renal Disease

Heart Failure

Major Depression/Major Depressive Disorder

Mental Health Disorders

Mental Health Disorders – Dementia addendum

Myocardial Infarction

Neoplasms

Neoplasms (breast cancer addendum No.1)  

Neoplasms (prostate cancer addendum No.2)  

Obesity/Morbid Obesity 

Peripheral Artery Disease (PAD)

Peripheral Vascular Disease  

Pressure Injury

Rheumatoid Arthritis  

Seizure Disorders  

Sick Sinus Syndrome  

Substance Use disorders

Vertebral Compression Fractures

ICD-10 Information

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). It contains codes that classify diseases and health problems. To learn more, review the following ICD-10 frequently asked questions and answers. All entities covered by the Health Insurance Portability and Accountability Act (HIPAA) of 1996 must now conduct healthcare transactions using the ICD-10 diagnosis and procedure codes.

  • Frequently Asked Questions and Answers

     

    • Q. What is CarePlus' standard for ICD-10 acceptance?
      A. CarePlus accepts ICD-10 codes on claims with a date of service or discharge date of Oct. 1, 2015, or after.
    • Q. Did CarePlus change medical necessity requirements because of the more specific codes that are available?
      A. Yes. CarePlus reviewed and updated medical necessity criteria to incorporate ICD-10 terminology and expanded coding.
    • Q. Did CarePlus update medical review policies, coverage determinations and payment determinations?
      A. Yes. CarePlus reviewed and updated medical necessity criteria to incorporate ICD-10 terminology and expanded coding.

     

Disclaimer: 

The information contained on this website provides a general overview of ICD-10 and should not be used as legal advice for implementation activities. We encourage you to seek any professional advice you may need, including legal counsel, regarding how the requirements affect your specific practice. CarePlus is providing the information on this site for general informational purposes only.

For ICD-10 information or training, CarePlus suggests contacting the American Medical Association, the Centers for Medicare & Medicaid Services (CMS), Workgroup for Electronic Data Interchange, American Health Information Management Association, American Academy of Professional Coders or other associations that provide ICD-10 training directly to healthcare providers.

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Last Updated:

01/16/2025