History of ICD-10 Coding
On January 15, 2009, the Secretary of the Department of Health and Human Services released a final rule calling for the adoption of a new edition of the International Classification of Diseases (ICD) standards known as the 10th edition using Clinical Modifications (CM) and the Procedure Coding System (PCS). The final rule adopted ICD-10-CM for reporting patient diagnoses and ICD-10-PCS for reporting hospital inpatient procedures, and both replaced ICD-9-CM.
The use of ICD-10-CM and ICD-10-PCS applies to all "Covered Entities," that is health plans, health care clearinghouses and health care providers, that transmit electronic health information in connection with the Health Insurance Portability and Accountability Act (HIPAA) transaction standards.
Another final rule was issued on January 15, 2009, calling for the adoption of an updated version to the current HIPAA electronic transaction standards (Version 5010). The newer versions replaced the existing HIPAA transaction standards on January 1, 2012.
On August 4, 2014, the Department of Health and Human Services issued a final rule implementing the Protecting Access to Medicare Act of 2014 by changing the compliance date for ICD-10, including the Official ICD–10–CM Guidelines for Coding and Reporting, and the Official ICD–10–PCS Guidelines for Coding and Reporting, from October 1, 2014 to October 1, 2015. It also requires HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.
Partial Code Freeze
The ICD-9-CM Coordination and Maintenance Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10, which would end one year after the implementation of ICD-10. The partial code freeze continued through October 1, 2015, the new planned implementation date. Regular updates to ICD-10 will began on October 1, 2016, one year after the implementation of ICD-10. See Partial Code Freeze for ICD-9-CM and ICD-10 for more information.
Benefits and Opportunities
The transition to ICD-10-CM/PCS allowed for precise diagnosis and procedure codes, resulting in the improved capture of health care information and more accurate reimbursement. Benefits of ICD-10-CM/PCS include:
- Improved ability to measure health care services, including quality and safety data
- Augmented sensitivity when refining grouping and reimbursement methodologies
- Expanded ability to conduct public health surveillance
- Decreased need to include supporting documentation with claims
- Strengthened ability to distinguish advances in medicine and medical technology
- Enhanced detail on socioeconomic, family relationships, ambulatory care conditions, problems related to lifestyle and the results of screening tests
- Increased use of administrative data to evaluate medical processes and outcomes, to conduct biosurveillance and to support value-based purchasing initiatives
AHA Central Office is committed to providing coding advice and resources to the coding community. Please check our website often as we keep you up-to-date on the latest coding news.
What is Coding Clinic for ICD-10-CM and ICD-10-PCS?
Coding Clinic for ICD-10-CM and ICD-10-PCS is the quarterly newsletter published by the American Hospital Association's Central Office on ICD-10-CM and ICD-10-PCS. The advice provided in Coding Clinic is the result of a formal cooperative effort between the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). In addition to these organizations, the Editorial Advisory Board consists of an expert panel of physicians representing the American Medical Association, the American College of Surgeons, the American Academy of Pediatrics and the American College of Physicians, as well as coding professionals representing healthcare facilities.
Published since 1984, Coding Clinic brings the latest official coding information to coding professionals, auditors, third-party payers, government agencies, and consultants who are interested in and dedicated to improving the accuracy and uniformity of medical coding. CMS' affirmation of the Coding Clinic as the official source of coding information is noted in the Federal Register, Vol. 74, No. 165, Thursday, August 27, 2009.
The Official Guidelines for Coding and Reporting (developed by the four cooperating parties) are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM and ICD-10-PCS. The instructions and conventions of the classification take precedence over guidelines. The guidelines provide additional instruction. Adherence to these guidelines when assigning ICD-10 diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The Coding Clinic is to be used as an official resource when the classification and the guidelines do not provide direction.