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History of ICD-10


Health Care Industry Use of Coded Data
1979 World Health Organization (WHO) adopts ICD-9 and United States adopts ICD-9-CM (clinical modification with procedure codes) for use in hospitals
1983 Inpatient prospective payment system—DRG links code data with reimbursement
1988 Medicare Catastrophic Coverage Act requires physicians to report conditions using ICD-9-CM


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World Moves to Updated Classification System

1994 WHO adopts ICD-10
1995 United States draft of ICD-10-CM made available
United States poised to adopt ICD-10-CM to align with WHO and other countries


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Stop Action

1996 HIPAA (Heath Insurance Portability and Accountability Act) enacted:
  • Code set standards established under the Administrative Simplification provision of the Social Security Act
  • New code set adoption process falls under legislative controls


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Legislative Steps to ICD System Conversion

2003 National Committee for Vital and Health Statistics (NCVHS) voted to recommend that the secretary of Health and Human Services move forward to adopt ICD-10-CM and ICD-10-PCS under HIPAA standards
2008 August: Notice of proposed rule making (NPRM) published in the Federal Register with a proposed implementation date of October 1, 2011, and a 60-day public comment period
October: Analysis of public comments to NPRM
2009 HHS publishes final rule (CMS 0013F 45 CFR, parts 160, 162) in the Federal Register, adopting ICD-10-CM and ICD-10-PCS effective October 1, 2013, with implementation timeline for version 5010 electronic transactions and ICD-10: http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf


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Effective Dates

2012 Version 5010 electronic billing process and format compliance on January 1, 2012 (except for small health plans; January 1, 2013)
2013 Implementation delayed one year
2014 Implementation delayed one year
 2015 ICD-10-CM/PCS compliance effective October 1, 2015, for all HIPAA-covered entities
 

Electronic Transaction Standards

  • Front Matter/Education—Clearer Instruction with defined data element rules
  • Technical Improvements—Consistent data across all transactions
  • Structural Changes—Modifications to physical components of data elements
  • Front Matter/Education—Clearer Instruction with defined data element rules
  • Technical Improvements—Consistent data across all transactions
  • Data Content—Elimination of redundant or ambiguous content requirements
  • Versions 5010 and D.0, health plans, including small health plans, health care clearinghouses and covered health care providers, will be required to be compliant on and after April 1, 2010

Federal Register; September 5, 2012; Vol. 77, No 172 p. 54663 - 54720

The implementation of ICD-10 was delayed from October 1, 2013 to October 1, 2014 by final rule CMS-0040-F issued on August 24, 2012 published in the Federal Register / Vol. 77, No. 172 / Wednesday, September 5, 2012 / Rules and Regulations; Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets; Final Rule
http://www.gpo.gov/fdsys/pkg/FR-2012-09-05/pdf/2012-21238.pdf

 

Health Insurance Reform: Modifications to the Health Insurance Portability and Accountability Act (HIPAA)—FINAL RULES

Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS

  • ICD-10-CM will be the standard code set for reporting and coding diseases, injuries, impairments, other health problems and their manifestations, to replace ICD-9-CM Volumes 1 and 2—All covered entities.
  • ICD-10-PCS would replace ICD-9-CM Volume 3, including the official coding guidelines, for the following procedures or other actions taken for diseases, injuries, and impairments on hospital inpatients reported by hospitals: prevention, diagnosis, treatment, and management—Inpatient only.
  • An ICD-10-CM/PCS Coordination and Maintenance Committee would be established.
  • October 1, 2011 is proposed as the compliance date for ICD-10-CM and ICD-10-PCS code sets for all covered entities.

History of ICD-10-CM
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History of ICD-10-PCS




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