About ICD-10 Coding
Partial Code Freeze Extended
The ICD-9-CM Coordination and Maintenance Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10, which would end one year after the implementation of ICD-10. On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.
The partial code freeze will continue through October 1, 2015, the new planned implementation date. Regular updates to ICD-10 will begin on October 1, 2016, one year after the implementation of ICD-10. See Partial Code Freeze for ICD-9-CM and ICD-10 for more information.
AHA Coding Clinic ICD-10 Update
On January 15, 2009, the Secretary of the Department of Health and Human Services released a final rule calling for the adoption of a new edition of the International Classification of Diseases (ICD) standards known as the 10th edition using Clinical Modifications (CM) and the Procedure Coding System (PCS). The final rule adopts ICD-10-CM for reporting patient diagnoses and ICD-10-PCS for reporting hospital inpatient procedures - both will replace ICD-9-CM.
The use of ICD-10-CM and ICD-10-PCS applies to all "Covered Entities," that is health plans, health care clearinghouses and health care providers that transmit electronic health information in connection with the Health Insurance Portability and Accountability Act (HIPAA) transaction standards.
Another final rule was issued on January 15, 2009 calling for the adoption of an updated version to the current HIPAA electronic transaction standards (Version 5010). The newer versions replace the existing HIPAA transaction standards on January 1, 2012.
Benefits and Opportunities
The transition to ICD-10-CM/PCS will allow for precise diagnosis and procedure codes, resulting in the improved capture of health care information and more accurate reimbursement. Benefits of ICD-10-CM/PCS include:
- Improved ability to measure health care services, including quality and safety data
- Augmented sensitivity when refining grouping and reimbursement methodologies
- Expanded ability to conduct public health surveillance
- Decreased need to include supporting documentation with claims
- Strengthened ability to distinguish advances in medicine and medical technology
- Enhanced detail on socioeconomic, family relationships, ambulatory care conditions, problems related to lifestyle and the results of screening tests
- Increased use of administrative data to evaluate medical processes and outcomes, to conduct biosurveillance and to support value-based purchasing initiatives
ICD-10-CM/PCS Rollout Plans for the AHA Central Office
During the transition from ICD-9-CM to ICD-10-CM and ICD-10-PCS, the AHA Central Office is committed to supporting the health care field with the clearinghouse function and publishing of AHA Coding Clinic.
Since many of the questions published in Coding Clinic for ICD-9-CM arose out of the need to provide clarification on the use of ICD-9 codes, there are no plans to translate all previous issues of Coding Clinic for ICD-9-CM into ICD-10-CM/PCS.
With the Fourth Quarter 2012 issue of Coding Clinic for ICD-9-CM, the AHA Central Office launched the publication of ICD-10-CM and ICD-10-PCS coding questions that were reviewed and approved through the same process used for all Coding Clinic questions.
Given the imminent compliance date for ICD-10-CM and ICD-10-PCS, the following timeline has been developed with the approval of the Cooperating Parties:
- Fall 2013: The last meeting of the AHA Coding Clinic Editorial Advisory Board (EAB) meeting where ICD-9-CM questions will be addressed.
- January 1, 2014: After 30 years of providing ICD-9-CM coding advice, the AHA Central Office will shift its attention to ICD-10-CM/PCS and will no longer accept nor respond to requests for ICD-9-CM coding advice.
Any ICD-9-CM questions received between October-December 2013 (after the last EAB meeting) will be answered by AHA staff based on existing previously published advice or previously approved EAB decisions.
- First Quarter 2014: Last issue of Coding Clinic for ICD-9-CM will be published. First issue of Coding Clinic for ICD-10-CM and ICD-10-PCS will be published.
The Secretary of HHS may not adopt ICD-10 as the standard code set for medical data prior to Oct. 1, 2015. Currently, hospitals use the 9th Edition of the International Classification of Diseases (ICD-9) for recording both patient diagnoses and procedures on medical claims. HHS had previously established Oct. 1, 2014 as the transition date to ICD-10. The AHA opposes delaying implementation of the ICD-10 coding system. Many hospitals have incurred substantial financial obligations in implementing ICD-10, and this delay will slow down the transition to value-based payment in the health system.
AHA Central Office is committed to providing coding advice and resources to the coding community. Please check our website often as we keep you up-to-date on the latest coding news.
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