AMA - ICD-10 Code Set

ICD-10 Code Set

In 2003, the Health Insurance Portability and Accountability Act (HIPAA) required physicians who do certain business transactions electronically to use HIPAA standard transactions and code sets. The code sets originally named under HIPAA to classify diseases was ICD-9. On January 15, 2009, the U.S. Department of Health and Human Services (HHS) announced that starting on October 1, 2013, ICD-10 will replace ICD-9 as the HIPAA adopted code set for use in inpatient settings for coding diagnoses and inpatient hospital procedures and in physicians’ offices and other outpatient settings for diagnoses. Please note that CPT will remains in place to identify procedural services in physician offices and outpatient settings.

HHS had originally proposed an earlier adoption date, however, thanks to significant advocacy efforts by the AMA and others, HHS decided to extend the compliance deadline. The Centers for Medicare & Medicaid Services (CMS) is the agency within HHS that will oversee the adoption of ICD-10.

HHS is requiring the move from ICD-9 to ICD-10 because they, and others in the health care community, believe the current code set, ICD-9, is outdated and lacks room for new codes and that ICD-10 provides greater code specificity and will provide better data for public health surveillance and research initiatives. Moving to ICD-10, however, will be costly to physicians and will require significant planning.

The National Center for Health Statistics (NCHS) maintains the ICD-10-CM code set for diagnoses. You can access information and the code set files on the NCHS Web site.

CMS maintains the ICD-10-PCS code set for inpatient procedures. You can access information and the code set files on the CMS Web site.

Differences between ICD-9 and ICD-10

The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the October 1, 2013 compliance deadline.

ICD-10-CM codes are the ones designated for use in documenting diagnoses. They are 3-7 characters in length and total 68,000, while ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The ICD-10-PCS are the procedure codes and they are alphanumeric, 7 characters in length, and total approximately 87,000, while ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes.

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, as well as other necessary investments.

Before the ICD-10 codes can be used however, physicians and others in the health care community must start using the new version of HIPAA transaction standards known as 5010 by January 1, 2012, as the current version, 4010, does not accommodate use of the ICD-10 codes.