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Three Years Until ICD-10?

September 9, 2008:

If the federal government gets its way, by the fall of 2011, ICD-10-CM will replace ICD-9-CM, volumes 1 and 2, as the standard code set for covered entities for reporting and coding diseases, injuries, impairments, other health problems and their manifestations.

The Department of Health and Human Services issued a notice of proposed rule making (NPRM) in the Federal Register on August 22, 2008, that proposes the adoption of ICD-10 effective October 1, 2011, for all covered entities (“HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS─Proposed Rule” [Federal Register; August 22, 2008]). It is important to note that the compliance date must occur on October 1 in order to coincide with the effective date of annual Medicare inpatient prospective payment system updates.

Additionally, ICD-10-PCS would replace ICD-9-CM volume 3, including the official coding guidelines, for the following procedures or other actions taken for diseases, injuries, and impairments on hospital inpatients reported by hospitals: prevention, diagnosis, treatment, and management. 

All covered entities under the Health Insurance Portability and Accountability Act would be required to use these codes when diagnoses and hospital inpatient procedures need to be coded in HIPAA transactions. ICD-10-PCS codes are used only for inpatient hospital procedures.

HHS cites these important issues as drivers for moving forward with adoption of ICD-10-CM and ICD-10-PCS:

  1. Space Limitations
    Additional need for new codes for reporting new and changing medical advancements (newly identified disease entities, new technologies and devices) has exhausted the functionality of the classification system

  2. Impact of Workarounds on Structural Hierarchy
    Some chapters can no longer accommodate new codes, with the result that any additional codes must be assigned to other topically unrelated chapters.

  3. Lack of Detail
    Emerging health care technologies, new and advanced terminologies, and the need for interoperability in electronic health records (EHRs) and personal health records (PHRs), support for pay-for-performance programs, development of rapid interventions for emerging diseases affecting international populations, utilization review, disease management, and research all require code specificity not available in  ICD-9-CM.

  4. Mortality Reporting and Biosurveillance
    One hundred thirty-eight countries have adopted ICD-10 for coding and reporting mortality data, and 99 countries have adopted ICD-10 or a clinical modification for coding and reporting morbidity data; as part of a global community, the United States must make sure its health care data represent current medical conditions and technologies using codes compatible with the international version.

Note: A simultaneously issued “Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards─Proposed Rule”updates the versions of the standards for electronic transactions originally adopted in the regulations. Version 5010 of the X12 electronic data transaction standards anticipates the eventual use of ICD-10 diagnosis codes and adds a qualifier as well as the space needed to report the number of characters that would permit reporting of ICD-10 diagnosis codes on professional claims.

Versions 5010 and D.0, health plans, including small health plans, health care clearinghouses, and covered health care providers, will be required to be compliant on or after April 1, 2010.

Nichole VanHorn
Clinical/Technical Editor


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