HHS mandates transition to ICD‑10
Effective October 1, 2013, the United States Department of Health and Human Services (HHS) has mandated the replacement of both the ICD-9-CM code sets now used to report health care diagnoses, and the CPT code sets now used to report health care procedures, with ICD-10 code sets. All HIPAA “covered entities” must make the change. This means that any service or encounter that occurs on or after October 1, 2013 must be coded using ICD-10 code sets.
The switch to ICD-10 is a major change for most healthcare providers and technology vendors, and the software and process changes required to comply with the new law will require a significant amount of time, money, and effort to implement. For these reasons, the use of the new codes will likely have a negative impact on healthcare operations in the short term. Due to the great effort needed, the implementation of ICD-10 has already been delayed from its original implementation date: In January 2009, the date was pushed back by two years, to October 1, 2013 rather than the previous proposal of October 1, 2011.
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (known as “ICD-10″) is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the World Health Organization (WHO). ICD-10 is in already in use in most major countries in the world.
Under WHO authorization, the US has developed its own Clinical Modifications (CM) of the International version of ICD-10. ICD-10-CM was developed by the National Center for Health Statistics under authorization of WHO. The US ICD-10 CM has over 68,000 codes. In addition, the US Centers for Medicare and Medicaid Services (CMS) developed ICD-10-PCS (Procedural Coding System) as a procedure code set that contains over 76,000 codes. These numbers can be compared to the 2012 editions of ICD-9-CM and CPT which contain 17,000 and 18,000 codes respectively.
As of October 1, 2013, all diagnoses will need to be reported in ICD-10-CM. In addition, inpatient procedures for hospitals will need to be reported in ICD-10-PCS (Procedural Coding System). Physician practices and outpatient healthcare providers will continue to report procedures using the CPT code set.
The primary reason cited for switching to ICD-10 is the increase in the number of codes. By increasing the number of codes, CMS and HHS have increased the granularity of the code sets. That is, the new codes are much more specific about the diagnosis identified and procedure performed. For example, in ICD-9-CM, a healthcare provider may report a broken bone. In ICD-10, there is a code to identify exactly which bone was broken. CMS and HHS hope that this increased granularity will provide the following benefits:
- Easier detection of fraud and abuse.
- Support for more detailed quality reporting.
- More refined and precise reimbursement.
The change to ICD-10-CM for reporting diagnoses across all of the healthcare — and the implementation of ICD-10-PCS for reporting inpatient procedures — will be an extremely challenging transition for everyone involved in the healthcare coding and billing processes. While the conversion to ICD-10 will be potentially disruptive, the change has been a long time coming. ICD-9 was adopted in 1979 and is now more than 30 years old. ICD-10 was finalized in 1999 and many countries have been using it for over 10 years. Plus, ICD-11 is currently in draft status and scheduled for final draft in 2015.