CMS Announces Delay in Use of ICD-10 Codes

Physicians and insurers were given two additional years to familiarize themselves with the next generation of diagnostic codes following a recent decision by federal regulators, but psychiatrists did not support the delay.

The Centers for Medicare and Medicaid Services (CMS) released a final rule in January that physicians, hospitals, and payers must adopt an updated version of the International Classification of Diseases code sets, or ICD-10, by October 1, 2013. This rule, among the last issued by the Bush administration, delayed the scheduled implementation of ICD-10 codes from October 1, 2011.

The World Health Organization (WHO) published its ICD-10 in 1993, and most nations use it as the basis for their versions. The diagnostic categories used in DSM-IV and DSM-IV-TR are identified by both ICD-9 and ICD-10 codes.

The delay followed complaints to CMS by some physician organizations, including the AMA, and health insurers that the 2011 deadline left insufficient time to upgrade practice and billing systems to the new code set, which is capable of tracking many more diagnoses with greater specificity.

The extension of the ICD-10 implementation deadline was supported by many physician groups as necessary to help physicians, coders, and others prepare for a smooth transition.

APA did not advocate for the postponement. In a letter to CMS last October, APA and other organizations called for quick implementation of ICD-10 to replace the “outdated” ICD-9-CM.

The version that will be used in the United States is ICD-10-CM.“ CM” stands for “clinical modification.”

“ICD-10-CM will allow for greater specificity in diagnosis and thus better disease tracking than can be currently found with ICD-9-CM,” wrote APA, the American Association for Geriatric Psychiatry, and the American Academy of Child and Adolescent Psychiatry.

Among the reasons cited in support of quick implementation is the inability of ICD-9-CM to accommodate new DSM diagnoses developed over the last two decades within the limited number of codes allotted for mental disorders, the need for clinicians and payers to keep closer track of the health of patients with chronic health conditions, and the need for“ fully harmonizing” the codes with DSM-IV.

Darrel Regier, M.D., M.P.H., director of APA's Division of Research and of the American Psychiatric Institute for Research and Education, told Psychiatric News that APA has been seeking implementation of a U.S. national version of the WHO-developed ICD-10 codes since 2000 to bring them up to date with the more specific disease codes under the international ICD-10 system

“We're disappointed that ICD-10 was not implemented more quickly,” Regier said. “When it is finally implemented, it will be 23 years since it was approved as a diagnostic set by WHO.”

The delay is likely to impact the development of DSM-V, for which APA was hoping to match DSM diagnoses with the ICD-10 codes. The delay will likely mean APA will perform “an approximation” of DSM-V diagnostic codes to older ICD-9 codes and then update them when ICD-10 is implemented, Regier said. DSM-V will be published in 2012.

ICD-9, developed over 30 years ago, contains 17,000 codes. ICD-10 contains more than 155,000 codes and can accommodate a host of new diagnoses and procedures. The limitations of ICD-9 have led CMS to begin assigning codes to unrelated chapters because many of the ICD-9-CM chapters are full. For example, codes related to neurological procedures have been placed under the cardiovascular chapter because there was no room for additional codes in the neurological chapter.

Another delay was granted by CMS for clinicians to adopt the so-called 5010 electronic transaction standards, which is the latest update on the specifications of how medical data can be transmitted under the Health Insurance Portability and Accountability Act (HIPAA).

Implementation of the transmission update is considered a prerequisite for moving to ICD-10. Under another final rule also issued in January, that deadline was extended from April 1, 2010, to January 1, 2012.

Officials in the Obama administration are reviewing both rules—among other regulations issued in the final days of the Bush administration.

“A transition of this magnitude will require a workable implementation process and timeline for all HIPAA-covered entities and comprehensive outreach and education initiatives to support health care providers, especially small physician practices, throughout this complex move to ICD-10,” wrote the AMA and other physician organizations in letter last October calling for delay of both ICD-10 and the 5010 electronic transaction standards.

Information on ICD-10 is posted at<www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm>.▪