In August 2008, the Department of Health and Human Services (HHS) announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10-CM (diagnosis) and ICD-10-PCS (hospital procedure) code sets. These code sets are already in use by other developed countries around the world. HHS initially declared that ICD-10 codes must be in use in the U.S. by October 1, 2013, but on February 16, 2012, HHS announced it would "initiate a process" to push back the ICD-10 compliance deadline to an unspecified later date.

The ICD-10-CM/PCS Final Rule requires HIPAA-covered entities to adopt the ICD-10-CM and ICD-10-PCS code sets. Adoption is not required for non-covered entities such as property and casualty insurance health plans, workers' compensation programs, and disability insurance programs that submit non-covered transactions like paper claims, quality reporting and patient assessment data sets. However, for many non-covered entities the benefits of adopting ICD-10 will outweigh the challenges of implementation.

• What is ICD-10? ICD-10 is the diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in use in almost every country in the world except the United States.
• Why Move Away from ICD-9? Over time, the use of ICD-9 coded data has expanded beyond its originally-intended scope. Today, the codes are used by different types of data collection and reporting systems to support the needs of a variety of stakeholders. However, the code set lacks the specificity to fully describe a disease state or procedure. Because of its structure, the ICD-9 system has limited space for adding new codes, often requiring multiple codes to accurately describe certain procedures. Adding confusion to the coding process, codes have been assigned to inappropriate chapters due to those space limitations.
• The Benefits of the ICD-10 Expanded Code Set The ICD-10 code set expands the field length of the code. This expansion enables the addition of codes to support advances in medicine and provide greater specificity in clinical documentation. The codes differentiate body parts, surgical approaches and devices used. Injuries are grouped by body part rather than category of injury. In particular,ICD-10-CM contains approximately 68,000 diagnosis codes, versus 13,000 codes in ICD-9 and new and more complex procedures will be assigned codes that accurately describe the procedure.

The specificity of ICD-10 will lead to more accurate payment, in contrast to the current system where new procedures are often inappropriately grouped. In its Final Rule, HHS notes that the benefits of ICD-10-CM and PCS will become apparent the year after the code set has been implemented.

edgeMED systems will be fully compliant for processing both ANSI 5010 and the ICD-10-CM code sets according to the timelines established by the U.S. Department of Health and Human Services (HHS).

• January 1, 2010 – edgeMED successfully submitted its changes to receive Level 1 certification.
• January 1, 2012 – edgeMED's systems began handling all current formats including the new ANSI 5010 standards for incoming claims and inquiries and for outgoing payer files and remittances.
• October 1, 2013 – edgeMED's systems will utilize the ICD-10-CM code set.

The healthcare landscape is changing quickly and dramatically. Many healthcare organizations are focused on meeting the American Recovery Reinvestment Act (ARRA) requirements to earn incentives for the Meaningful Use of an Electronic Health Record (EHR), yet new regulatory requirements will soon be imposed that obligate providers to submit claims with all new coding in order to be reimbursed. This change from ICD-9 to ICD-10 will force clients to modify their workflows and upgrade their clinical and financial systems to avoid disruption to their workflow and cash flow.

At edgeMED, we consider ourselves to be your partner as you embark on the changes needed to meet regulatory compliance, and we are ready to work with you to help you avoid disruption to your practices and organizations. edgeMED is committed to assisting clients with a smooth and timely transition to ICD-10.

You can find more about ICD-10 at www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp
on the Centers for Medicare & Medicaid Services (CMS) ICD-10 Website.