ICD-10 Code Sets will replace ICD-9-CM on October 1, 2011

Proposed Change Would Improve Disease Tracking and Speed Transiton to an Electronic Health Care Environment

"We are taking a giant stepforward toward developing a health care system that focuses on quality and affordability through the implementation of health information technology,"  HHS Secretary Mike Leavitt 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 implmentation of these new codes."

In 2000, under authority provided ty the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the ICD-9-CM code sets were adopted for use in the administrative transactions by both the public and private sectors to report dianoses and inpatient hospital procedures.  Covered entities required to use the ICD-9-CM code sets include health plans, health care clearinghouses, and health care providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS. ICD-10 is already used widely in other parts of the world and the US healthcare system is behind other countries in adopting the standard.

Developed almost 30 years ago, ICD-9- is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses.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 only 17,000 codes and is expected to start running out of available codes next year.  By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures.  The additional codes will provide more detail in electronic transactions and will also help improve efficiencies by helping ientify specific health conditions such as Methicillin-Resistant Staphylococcus aureus (MRSA) and other conditions.

"We recognize that the transition to ICD-10 will require some upfront costs," said CMS Acting Administrator Kerry Weems" 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 health care and other initiatives." 

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.  The currently adopted standard, Version 4010/4010A1 of the American Standards Committee X12 group, cannot accommodate the much larger ICD-10 code sets.   

Under the updated transaction standards proposed rule, compliance with Version 5010 (health care transactions) would be required by April 1, 2010.  

Both regulations may be viewed at:  www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage.  

Comments on the ICD-10 code sets proposed rule are due by 5:00 p.m. Eastern time on October 21, 2008

Comments on the updated transaction standards proposed are due by 5:00 p.m. Eastern time on October 21, 2008.  

Fact sheets describing both proposed rules will be forthcoming at

http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

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