Medicare
CMS Proposes Transition to Expanded
ICD-10 Code Sets by October 2011       
The Centers for Medicare & Medicaid Services announced Aug. 15 a proposed rule to require health care providers to shift to a new, greatly expanded health care coding system beginning in October 2011.

The proposed rule would require a move from the International Classification of Diseases, Ninth Revision (ICD-9) to the International Classification of Diseases, Tenth Revision (ICD-10).

In a separate proposed rule, CMS said providers would be required to adopt new technology standards for electronic transactions that are necessary to use the new ICD-10 codes.

The proposed rules are scheduled to appear in the Aug. 22 Federal Register.

Entities covered by the requirement, and the new proposed rule, are health plans, health care clearinghouses, and health care providers that transmit electronic health information in accordance with HHS standards.

The changes would mean that providers would go from having 17,000 procedure and diagnoses codes in ICD-9 to more than 155,000 such codes in ICD-10. CMS said the expanded number of codes would accommodate new procedures and diagnoses and better enable implementation of electronic health records because of the greater level of detail that would be available in electronic transactions about procedures and diagnoses via ICD-10 coding.

"This granularity will also help to improve efficiencies by helping to identify specific health conditions such as Methicillin-Resistant Staphylococcus aur;eus (MRSA) and other conditions," CMS said.

In a news release, Health and Human Services Secretary Michael O. Leavitt said the expanded ICD-10 code sets also would better support quality reporting initiatives, pay-for-performance programs, and bio-surveillance.

"We are taking a giant step forward toward developing a health care system that focuses on quality and affordability through the implementation of health information technology," Leavitt said.

Congress mandated in the Health Insurance Portability and Accountability Act of 1996 that the ICD-9 code sets be adopted by private and public payers in 2000 to report diagnoses and inpatient hospital procedures.

The timing of adopting of the ICD-10 code sets raised concerns in the health care industry in 2006, when Congress proposed requiring that the standard become effective in October 2010. At that time, health plans and others said the move was too fast to ensure the transition would be done correctly and without risk of fraud in the system.

"Now is the right time to move forward with the transition from ICD-9 to ICD-10," CMS acting Administrator Kerry Weems said in the news release.

Weems also acknowledged that the transition to ICD-10 would be costly at first for providers but said delaying implementation would create additional future costs.

CMS will accept comments on the rules until Oct. 21.

The proposed rules are at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage. Fact sheets on the rules are at http://www.cms.hhs.gov/apps/media/fact_sheets.asp.