Frequently Asked Questions About the Transition to ICD-10-CM for School-Based
Services Providers
ForwardHealth has developed this Frequently Asked Questions document to provide answers to
International Classification of Diseases, 10th Revision, Clinical Modification
(ICD-10-CM)-related questions
submitted by school-based services (SBS) providers. Additional SBS-specific ICD-10-CM information has
been communicated in the July 2015
ForwardHealth Update
(2015-31), titled “School-Based Services
Providers Will Be Required to Use ICD-10-CM Diagnosis Codes on Claims with Dates of Service on and
After October 1, 2015” and published to the Resources for School-Based Service Providers page of the
Portal. School-based services providers are advised to check the Portal page regularly to view current
communications and other ICD-10-CM information.
School-based services providers that have additional ICD-10-CM questions that are not addressed in this
document may submit them to ForwardHealth via email at
VEDSICD10Support@wisconsin.gov
. This email
address may also be accessed from the Resources for School-Based Services Providers page of the Portal
by clicking the Submit an ICD-10 Question to ForwardHealth link.
As a reminder, providers are required to continue using
International Classification of Diseases, Ninth
Revision, Clinical Modification
(ICD-9-CM) diagnosis codes on claims with dates of service (DOS) before
October 1, 2015. Current policy and claims information can be found in the ForwardHealth Online
Handbook.
1. Question: What is ICD-10-CM?
Answer: ICD-10-CM is a coding system used to record a patient’s state of health to a high degree of
specificity. ICD-10-CM codes are alphanumeric and are composed of three to seven digits.
2. Question: How is the ICD‐10-CM code set different than the ICD‐9-CM code set?
Answer: The ICD‐9-CM codes are primarily numeric and have three to five digits, whereas ICD‐10-
CM codes are alphanumeric and contain three to seven characters. Additionally, descriptions between
the code sets are different. Refer to the CMS ICD‐10-CM website for more information regarding ICD‐
10-CM codes.
3. Question: Why are ICD-10-CM codes being required?
Answer: ICD-10-CM codes are being required by ForwardHealth in response to the CMS mandate
finalizing October 1, 2015, as the compliance date for health care providers, health plans, and health
care clearinghouses to transition to the ICD-10-CM code set.
4. Question: Do we have to wait until October 1, 2015, to start using ICD-10-CM codes on claims?
Answer: Yes, any claims submitted to ForwardHealth with DOS before October 1, 2015, must
indicate ICD-9-CM
codes, not ICD-10-CM codes. Any claims submitted with DOS before October 1,
2015, that indicate ICD-10-CM codes will be denied. School-based services providers should,
however, ensure that their coders and billers are ready to use ICD-10-CM codes for DOS on and after
October 1, 2015.
5. Question: Where can the ICD-10-CM code set be found?
Answer: Because the transition to ICD-10-CM is a national mandate, ForwardHealth is referring
stakeholders to the CMS website for ICD-10-CM code information. The CMS website includes a link to
