Change has come again to ICD-9 diagnostic codes
Melanie Witt, RN, CPC, COBGC, MA (Reimbursement Advisor, November 2011)
Health and Human Services (HHS) Secretary Kathleen G. Sebelius recently announced that the date for compliance with International Classification of Diseases, 10th Edition, diagnosis and procedure codes, or ICD-10, has been changed from October 1, 2013, to October 1, 2014.
Secretary Sebelius noted that the date change has been made in reaction to many providers’ concerns about the administrative burdens they will face in years ahead due to implementation of electronic health records and the Affordable Care Act.1
“ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health-care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes,” said Secretary Sebelius.”1
The final rule was issued by the Centers for Medicare & Medicaid Services, and published in the Federal Register on September 5, 2012. The rule states that, “The change in the compliance date is intended to give covered health-care providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition by all covered entities.”2
Adoption will “increase standardization within HIPAA standard transactions and provide a platform for other regulatory and industry initiatives. Their adoption will allow for a higher level of automation for health-care provider offices, particularly for provider processing of billing and insurance related tasks, eligibility responses from health plans, and remittance advice that describes health-care claim payments.”2
Decision based on costs versus savings
HHS is aware that health-care plans, hospitals, and physician practices are currently in the process of implementing the ICD-10 due to the anticipated 2013 compliance date. It is estimated that the 1-year delay may cost the entire health-care industry $1 billion to $6.6 billion. However, HHS also anticipates substantial savings ($3.6 billion to $8 billion) by avoiding costs that could incur if a significant number of providers are unprepared for the transition to ICD-10. Possible consequences of implementing ICD-10 in 2013 are: 1) health-care providers and plans could have to manually process claims for claims to be paid and 2) small health-care providers might have to arrange for loans or lines of credit to continue to provide health-care services because of delayed payments. The decision to delay administration of ICD-10 was based on these factors.3
The American Health Information Management Association (AHIMA) will continue to assist the industry through the implementation process. AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, FACHE, CAE, wrote on August 24, 2012, “ICD-10-CM/PCS implementation is inevitable, but today’s news gives the health-care community the certainty and clarity it needs to move forward with implementation, testing, and training. We realize that a few are still apprehensive about the implementation process, and that is why AHIMA remains committed to assisting the health-care community with its transition to a new code set that will lead to improved patient care and reduced costs.”3
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