HHS announces deadline for switch to ICD-10 codes, electronic transition standards

Physicians must replace the current set of codes they use to report health care diagnoses and procedures with a new set containing almost 10 times more combinations by Oct. 1, 2011, raising criticism from some groups who question how quickly physician practices can make the large-scale changes. The timeline comes under a proposal announced in August by the U.S. Department of Health and Human Services.

The International Classification of Diseases, Tenth Revision, Clinical Modification, used for diagnosis coding, and ICD-10, Procedure Coding System, used for inpatient hospital procedure coding, encompass 155,000 possible code combinations. Its predecessor, ICD-9-CM Volumes 1, 2 and 3 contain 17,000 possible combinations and are expected to run out of available code combinations by next year. ICD-9-CM were developed nearly 30 years ago and adopted under the Health Insurance Portability and Accountability Act of 1996.

The ICD-10 codes will affect health care claims, physician reporting, billing, information technology, revenue management and other electronic HIPAA transactions. The greater number of combinations should allow CMS to keep up with new diagnoses and inpatient procedures to “ensure more accurate payments for new procedures, fewer rejected claims, improved disease management and harmonization of disease monitoring and reporting worldwide,” according to the release.

HHS says that the United States is one of the few developed countries not using ICD-10 and that adoption has been delayed due to the cost and timeline of implementing new information technology systems.

To accommodate electronic transactions under the more expansive code set, HHS has proposed a separate regulation to adopt the updated X12 standards, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0., for pharmacy claims. Physicians use these standards when electronically conducting health care administrative transactions such as claims, remittance, eligibility, and claims status requests and responses, according to HHS.

Cindy Hughes, AAFP coding and compliance specialist, says the 5010 transition will be the larger expense to most physicians as the software vendors for their practice management systems will charge to upgrade or replace the current system as they did when the first transaction changes occurred in 2000 and with the National Provider Identifier.

The different structure of the codes will be like learning a different language, Hughes says. “This is going to be a big transition for both coders and physicians. Everything will have to be changed twice, starting with practice management software and then everywhere else ICD-9 codes are used.”

Because physician offices must train staff and adopt new information technology systems to handle the new set, the Medical Group Management Association recommends adopting ICD-10 only after the 5010 transactions have been in place for a few years. In an MGMA press release, President and CEO William F. Jessee, M.D., said that comprehensive system and workflow changes of this magnitude require all stakeholders—medical groups and their vendors, clearinghouses and health plans—to work together.

Jessee said in the MGMA press release, “CMS should have instituted pilot testing in a broad array of clinical settings before publishing the rule to fully ascertain the impact of ICD-10 on the health care system. It is a recipe for disaster to force such a change without pilot testing and allowing sufficient time for implementation.”