The Department of Health and Human Services (HHS) announced on Friday a proposed regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and inpatient procedures with the more advanced ICD-10-CM code set currently used in other nations. Under the proposal, implementation will take place October 1, 2011.
A separate proposal would adopt the X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as healthcare claims. According to HHS, adoption of Version 5010 is essential to use ICD-10-CM.
Nearly 30 years old, ICD-9-CM will run out of possible code combinations by next year. The present code set includes 17,000 codes, while ICD-10-CM includes more than 155,000 possible code combinations. This greater number of combinations allows ICD-10-CM to expand and keep up with new diagnoses and inpatient procedures. According to a statement on the American Health Information Management Association Web site, the United States is virtually the last industrialized country to adopt ICD-10-CM.
According to the HHS announcement, the United States would adopt ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient hospital procedure coding. The new codes would replace the ICD-9-CM volumes 1 and 2 for diagnosis coding and volume 3 for procedure codes.
Gloryanne Bryant, BS, RHIA, RHIT, CCS, senior director of coding and health information management (HIM) compliance for Catholic Healthcare West in San Francisco, says having a proposed implementation date will be helpful in preparing for the transition and develop a timeline. "I’m very excited and elated that it has come to this," she says.
The HHS announcement first surprised DeAnne W. Bloomquist, RHIT, CCS, a coding and compliance consultant and the president of Mid-Continent Coding, Inc., in Overland Park, KS. However there was reason to think something was coming, she says, because of hints that had appeared in CMS publications and the Federal Register for several months preceding the HHS announcement.
Sheri Poe Bernard, CPC, CPC-H, CPC-P, vice president of clinical coding content at the American Academy of Professional Coders in Salt Lake City, suggests that many HIM professionals may be concerned that the three-year preparation time frame the proposed regulation specifies is not enough. "We expect there to be a public outcry regarding the short timetable established in the proposed rule," she says. "We hope that the government will listen to the concerns of physicians, payers, and facilities that understand the complexity of ICD-10 implementation and request more time to effect a cohesive transition." Bernard, who has traveled extensively lecturing on ICD-10-CM, is herself concerned by the widespread lack of preparation she has encountered.
Bloomquist thinks the three-year transition is "a done deal" upon CMS adoption, but admits it will be interesting to see the character and effect of the comments.
It is very important to understand that the transition doesn’t affect coding alone, says Bernard. It involves physician reporting, billing, information technology, and revenue management, to name just a few, she adds.
All sources agree that ICD-10-CM represents an excellent opportunity for the HIM profession to recruit and train a new generation of coders and to bring the nation’s present coding profession on board with the change. Bernard says that as the best authorities on the topic, coders have a chance to become heroes in their facilities by guiding the transition as its influences changes in many other departments.
The comment period for the ICD-10-CM code sets proposed rule and updated transaction standards proposed rule ends on October 21.
To view the regulations, visit the HHS Web site.
This article first appeared as a breaking news item from the editors of Briefings on Coding Compliance Strategies, a monthly newsletter by HCPro, Inc.