ICD-10 Compliance Date Extended Forward — It’s no secret that the Department of Health and Human Services (HHS) is working to transition from using ICD-9 codes to adopting ICD-10 codes in an effort to improve the overall health care system. In fact, it’s now more than two years since the final rule was released. The good news is that while health care entities across the nation have been working to prepare for the change, they now have some more time to get up to speed.

Initially the deadline for transition completion was set for October 1, 2013; however, HHS’s Secretary Kathleen G. Sebelius recently announced that HHS will initiate a process to postpone the date that health care entities have to comply. This date is still to be announced.

“ICD-10 codes are important to many positive improvements in our health care system,” said Sebelius.  “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

What’s the difference between ICD-9 and ICD-10?

Both ICD-9 and ICD-10 code sets are used to report medical diagnoses and inpatient procedures, but ICD-10 codes provide more robust and specific data that will help to improve patient care and enable the exchange of health care data. In fact, the rest of the world has long utilized ICD-10.

ICD-10 consists of two parts:

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

In a nutshell, the transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

Who has to transition?

According to the Centers for Medicare & Medicaid Services (CMS), ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Everyone covered by HIPAA who transmits electronic claims must also switch to Version 5010 transaction standards. The change to ICD-10 does not affect CPT coding for outpatient procedures.

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