icd-10 coding

ICD-10 Coding – AHA Central Office Policy

ICD-10 Coding (International Classification of Diseases) is the standard known as the 10th edition using Clinical Modifications (CM) and the Procedure Coding System (PCS). The final rule adopts ICD-10-CM for reporting patient diagnoses and ICD-10-PCS for reporting hospital inpatient procedures – 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 replace 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.

Benefits and Opportunities

The transition to ICD-10-CM/PCS allows 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.

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 ended one year after the implementation of ICD-10. Regular updates to ICD-10 began on October 1, 2016.

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