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
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to replace the "outdated" ICD-9-CM.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
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.