As youve probably heard by now, the Centers for Medicare and Medicaid Services (CMS) have announced a date for implementing the ICD-10 system within the United States. On August 18, the Department of Health and Human Services (HHS) announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets that are now used to report health-care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011.

In a separate proposed regulation, HHS would adopt the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as health-care claims. Version 5010 is essential for using the ICD-10 codes.


ICD-9 vs. ICD-10

In 2000, under authority provided by 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 diagnoses 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.

Developed almost 30 years ago, the ICD-9 system is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses.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 help enable the implementation of electronic health records because they will provide more detail in the electronic transactions.

The ICD-10 code sets proposed rule would concurrently adopt the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding.

The new codes would replace the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, 9th Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively. We currently use only the diagnosis coding portion of the ICD system for our practices.

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.


Start Planning Now

So, what does this mean to you?

At the least, it means a departure from a system that weve been using for years.
At the most, it will create significant disruptions in everything we do. This includes delayed claims processing, increased administrative costs due to implementing new systems within your practice, and total disruption within the health-care reimbursement system.

One thing is very clear: Its never too late to start planning for this very significant change, so begin planning for this change in your practice now! In the meantime, well provide more detailed information in future articles.

For more CMS resources on the subject, go to

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Vol. No: 145:10Issue: 10/15/2008