Background on the Transition to ICD-10

The following information provides some background on the upcoming ICD-10 transition.

CMS published the original rule on January 16, 2009 - HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS. The rule was revised and a final rule was posted August 24, 2012 that requires all HIPAA covered entities to adopt the ICD-10 code sets which replaces the ICD-9 code sets with a compliance date of October 1, 2014 - Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD–10–CM and ICD–10–PCS) Medical Data Code Sets. (See links to rules below)

ICD-10 code sets contain greater clinical detail and specificity which supports the collection of improved clinical information. The number of diagnosis/procedure codes is greatly expanded (from about 18,000 to over 141,000 codes). ICD-10 will provide a number of advantages such as:

• Improved claims payment accuracy and efficiency
• Improved accuracy of quality measures
• Reduced need for attachments to explain the patient's condition
• Detailed clinical information in a single ICD-10 procedure code
• Improved tracking of public health measures and population epidemiologic research
• Better identification of risk and severity
• Expanded flexibility for coding new diseases and medical procedures in future

Providers and other trading partners must fully understand where and how ICD-9 codes are used within their organizations so the new ICD-10 code sets can be implemented properly within their business and billing practices.

As NC DHHS OMMISS ICD-10 project implementation activities progress for NCTracks, we will keep our trading partners informed and assist in providing meaningful resources to ensure implementation by the compliance date.