On July 31, 2014, the U.S. Department of Health and Human Services (HHS) issued an updated rule finalizing October 1, 2015, as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready on October 1, 2015.
On January 16, 2009, the U.S. Department of Health and Human Services (DHHS) released a final rule 45 Code of Federal Regulations (CFR) Parts 160 and 162, which mandates the transition from the International Classification of Disease, 9th Revision (ICD-9) to the more specific International Classification of Disease, 10th Revision (ICD-10) Clinical Modification (CM) and Procedure Coding System (PCS) code sets. Currently, ICD-9 is the Health Insurance Portability and Accountability Act (HIPAA) mandated code set for coding diseases, injuries, impairments, and health care encounter. The conversion to ICD-10 will be implemented October 1, 2014.
ICD-10 will enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes. The new classification system provides significant improvements through greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine.
The transition is anticipated to have a significant impact on Medi-Cal, health plans, health care providers and trading partners. The changes in the ICD-10 code set might impact practices in the following:
- Software upgrades
- Billing practices (upgrade to forms/manuals)
- Electronic Health Records
- Business Processes
The transition to the enhanced specificity of medical conditions and increased level of detail of the ICD-10 code set will better reflect current medical practice and help:
- Govern reimbursement
- Monitor health of the population
- Track trends in disease and treatment
- Optimize health care delivery
- Identify Fraud and Abuse
Below are external links that provide additional information on ICD-10 and will lead you away from the Department of Health Care Services.
Medi-Cal HIPAA ICD-10
CMS Road to 10
ICD-10 Latest News