In a move that heralds sweeping change in how medical bills are coded, the Department of Health and Human Services has announced a proposed regulation to change the ICD-9 code sets with ICD-10 code sets, effective Oct. 1, 2011.
Health and Human Services Secretary Michael Leavitt said ICD-10 codes are key to supporting an electronic healthcare system.
"We are taking a giant step forward toward developing a healthcare system that focuses on quality and affordability through the implementation of health information technology," he said. "The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance and other critical activities. Conversion to ICD-10 is essential to development of a nationwide electronic health information environment, and the updated X12 transaction standards are a critical step in the implementation of these new codes."
HHS has also proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions such as healthcare claims. Version 5010 is essential to use of the ICD-10 codes.
Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains 17,000 codes and is expected to start running out of available codes next year.
The ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures.
The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions, proponents say. This granularity will also help to identify specific health conditions.
"Now is the right time to move forward with the transition from ICD-9 to ICD-10," said Centers for Medicare and Medicaid Services Acting Administrator Kerry Weems. "We recognize that the transition to ICD-10 will require some upfront costs, but each year of delay would create additional costs, both because of the limitations of ICD-9 and because of the need to employ the greater precision that ICD-10 codes provide to support value-based purchasing of healthcare and other initiatives."
The ICD-10 code sets proposed rule would concurrently adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. The new codes would replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
Updated versions of current HIPAA electronic transaction standards require the use of the ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorization and other widely used transactions.
Under the updated transaction standards proposed rule, compliance with Version 5010 (healthcare transactions) and Version D.0 (pharmacy claims) would be required by April 1, 2010.
What will your organization do to prepare for the switch from ICD-9 to ICD-10? Send your comments to Editor Bernie Monegain at bernie.monegain@medtechpublishing.com