Health Panel Urges Government To Adopt ICD-10 for Coding

The National Committee on Vital and Health Statistics (NCVHS) recommended to the Department of Health and Human Services in November that it initiate regulations to adopt the new and expanded International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS), to reimburse claims submitted by physicians and hospitals to the Centers for Medicare and Medicaid Services (CMS).

NCVHS is responsible for ensuring that national health data standards are compliant with the administrative simplification provisions of the 1996 Health Insurance Portability and Accountability Act (HIPAA).

The ICD-10-PCS developed by CMS would replace Volume 3, Procedures, of the current ICD-9-CM, which hospitals use for reporting inpatient procedures. The ICD-10-CM would replace ICD-9-CM, Vol. 1 and Vol. 2, according to the NCVHS.

CMS issued the final rule on electronic transactions and code sets last February (Psychiatric News, May 2, 2003). In September CMS clarified that it would continue to allow psychiatrists and other clinicians to use the DSM-IV criteria and descriptors to determine the ICD-9-CM service codes for Medicare and Medicaid beneficiaries (Psychiatric News, November 21, 2003).

The ICD-9-CM was developed about 24 years ago and is considered out of date and limited by many medical groups, including APA.

The NCVHS urged HHS Secretary Tommy Thompson to use the proposed rulemaking process to invite comments on concerns presented to the committee in testimony and letters. These include how to minimize the costs of transitioning to the new ICD-10-CM and -PCS and what timeframes are needed to implement the necessary changes, according to the letter from NCVHS to HHS.

NCVHS, based on input it received, recommended that HHS allow the final rule to be implemented over a two-year period.

NCVHS Chair John Lumpkin, M.D., M.P.H., said in the letter that the benefits of adopting the ICD-10-CM and -PCS include “facilitating improvements to the quality of care and patient safety, fewer rejected claims, improved formation for disease management, and more accurate reimbursement rates for emerging technologies.”

Lumpkin clarified “that this would not affect the use of other code sets under HIPAA such as the Clinical Procedural Terminology-4th Edition (CPT-4) published by the American Medical Association and the Healthcare Common Procedure Coding System (Level II HCPCS).”

“We expect that CMS will support the use of the crosswalk between the DSM-IV and ICD-10-CM as it has with the ICD-9-CM,” Darrel Regier, M.D., M.P.H., told Psychiatric News. Regier directs the APA Office of Research and the American Psychiatric Institute for Research and Education.

“The ICD-10-CM will be a major step forward since it more accurately reflects the disorder names adopted by DSM-IV and the World Health Organization in the early 1990s,” he continued. “We expect that HHS will propose the adoption of ICD-10-CM in the fall of 2007. Once comments are received in the review process, APA will publish a coding revision of the DSM-IV to update the linkage between DSM-IV and ICD-10-CM. Our expectation is the DSM-V will not be published until at least 2010.”

The NCVHS letter to HHS is posted online at www.ncvhs.hhs.gov/031105lt.htm. ▪