On January 16, 2009, the U.S. Department of Health and Human Services (“HHS”) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (“HIPAA”) must transition from ICD-9 diagnosis and procedure codes to ICD-10 diagnosis and procedure codes. The new ICD-10 code set was created to provide greater detail in reporting healthcare diagnosis and procedure codes.  ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The U.S. is the only industrialized nation not using an ICD-10-based classification system.

After a postponement of the compliance date by HHS early in 2012, the use of ICD-10 diagnosis codes for all claims and ICD-10procedure codes for inpatient claims will be mandated for dates of service on and after October 1, 2014.  Current Procedural Terminology (“CPT”) and Healthcare Common Procedure Coding System (“HCPCS”) codes are not a part of this transition.

Successful transition to ICD-10 requires providers to begin planning now for this transition.  Do not delay!  Below are some suggested action steps to help providers move toward compliance with this federally mandated requirement:

  • Clinical Documentation.  Review electronic and paper forms (i.e., encounter forms, quality forms, superbills), as well as your electronic health record systems. Talk with your practice management software vendors about accommodations for ICD-10.  See if your contracts include upgrades as part of your agreement.  Establish a software transition plan including testing.
  • Business Processes.  Review work flows and business processes; assess training needs for staff members who code claims or assign ICD codes.  Expect 16 hours of training for physician practice coders; 50 hours for hospital coders.
  • Payor Contracts.  Review and address any payor contract where reimbursement and claims pricing is based on ICD codes.

Blue Cross Blue Shield of Alabama and the Centers for Medicare and Medicaid Services are working to educate the provider community and vendors on this transition.  Look for webinars, articles, and online courses for ICD-10 training opportunities.  Specialty societies and other professional organizations are also offering specialty-specific ICD-10 training.  Software/systems vendors are also an important source of information and training.