Medical practices have to phase out to HIPAA ICD-10 by October 1, 2015

Key Takeaway:

Phasing out the HIPAA ICD-9 and ushering in the HIPAA ICD-10 is a massive exercise required under the Protecting Access to Medicare Act of 2014. Hospitals and other healthcare providers have to get used to a set of codes that is different from what was being practiced for over three decades.

The HIPAA "ICD-10" is a medical codes set from HIPAA. It stands for the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). This term also includes another classification, the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).

A brief understanding of the differences between ICD-10-CM and ICD-10-PCS

ICD-10-CM and ICD-10-PCS are quite different from each other. The ICD-10-CM diagnosis code will be replacing ICD-9-CM, Volumes 1 and 2. While ICD-10-CM will continue to be used to report diagnoses made in all clinical settings; ICD-10-PCS is a procedure code set that is set to replace the ICD-9-CM Volume 3. Hospital inpatient procedures are the only item to report which the ICD-10-PCS will be used.

Comprehensive and complex

The HIPAA ICD 9 will now be replaced by the HIPAA ICD-10 code set with effect from October 1, 2015. This transition is considered very elaborate, complex and expensive, as this is a gargantuan mandate that the federal government does not fund. The Department of Health and Human Services (HHS), which is to oversee the transition, extended the deadline for the date of phasing out into HIPAA ICD-10 by a year acknowledging the practical difficulties and costs associated with implementing a code set of such high proportion.

Major differences in coding practices

The ICD-9, which is the extant principle, has been around for three decades, necessitating changes into this code set.

  • The ICD-9-CM diagnosis codes are 3-5 digits in length and number just over 14,000, while HIPAA ICD-10 diagnosis code consists of 3-7 length characters and total 68,000
  • The ICD-9-CM procedure codes are only 3-4 numbers in length and total approximately 4,000 codes, while the HIPAA ICD-10-PCS are alphanumeric procedure codes that are 7 characters in length, and total approximately 87,000

No need to replace the CPT

Since the HIPAA ICD-10-PCS will only be used to report inpatient hospital procedures; it will continue to be used along with the Current Procedural Terminology(CPT), which deals with codes used for outpatients.

The scale of transition

Transitioning to HIPAA ICD-10 is expected to have an effect on all physicians. A pan-US exercise of this scale requires major software or system upgrades or replacements, large-scale training and planning, apart from many other unavoidable investments. The factors that will make this complex include:

  • The dramatic increase in the number of codes
  • Change being brought about in the number of characters per code
  • Increase in the specificity of the code

Costs of phasing out

The costs for transitioning for just small firms are expected to be between $56,000 and $226,000.

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