CMS to study ICD-10 codes

WASHINGTON – As the Centers for Medicare & Medicaid Services enters a new fiscal year, it’s beginning to take a fresh look at the future implementation of ICD-10 codes.

One step in that process came last month, when the CMS announced a one-year contract with the American Health Information Management Association to begin assessing the impact on CMS if ICD-9 code sets, currently used in U.S. healthcare transactions, are replaced with ICD-10 versions.

While full use of ICD-10 codes for claims is still a ways off, CMS’ announcement indicates that healthcare organizations should begin their own assessments of transition strategies.

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“The awarding of this contract reflects CMS’ commitment to ensuring that the transition from ICD-9 to the ICD-10 code sets will be thoughtfully planned and implmented throughout CMS and the healthcare community,” said Kerry Weems, CMS’ acting administrator.

“While we are still assessing the implementation and timing of the ICD-10, our proactive approach should send a signal to hospitals and other stakeholders who use the ICD-9 coding to begin making their own transition plans.”

The Weems statement surprised Dan Rode, AHIMA’s vice president of policy and government relations, because it implies that CMS wants to move the industry down the path toward adoption of ICD-10 in coding.

Many view ICD-10, with its 210,000 diagnosis and procedure codes, as a more robust and descriptive set than the ICD-9 codes, which have been in place for nearly three decades. ICD-10 codes were developed 15 years ago and are used in many industrialized countries.

However, adoption of ICD-10 has been a matter of contention within the healthcare industry. AHIMA and several other provider organizations continue to seek implementation of ICD-10. In June, several industry organizations wrote Health and Human Services Secretary Michael Leavitt, asking for federal assistance in moving to ICD-10 code sets by October 2011. However, some insurers, notably the Blue Cross and Blue Shield Association, have opposed the new system, citing high costs for transition which make it insufficient for the investment.

A Congressional effort to bring about a change stalled last year when Congress failed to enact Health Information Technology Promotion Act of 2006. The legislation contained a provision mandating the use of the new code set by October 2010.

Under the year-long contract, AHIMA will analyze CMS’ systems, policies and operations to determine potential effects of the transition, said Susan Fenton, director of the professional organization’s Foundation of Research and Education. The contract includes four option years, she said.

The contract also follows a push by healthcare organizations to upgrade HIPAA transactions to the ASC X12 version 5010. Such a move is important to enable the U.S. healthcare community to upgrade to the ICD-10 classification standard, AHIMA indicated in testimony to the National Committee on Vital and Health Statistics in late July.