ICD-10-CM/PCS Final Rule

The Centers for Medicare & Medicaid Services has released a final rule for replacing the 30-year-old ICD-9-CM code set with ICD-10-CM and ICD-10-PCS.  The final rule outlines the effective date as 60 days after publication in the Federal Register, and the compliance date for the two classification sets is established as October 1, 2013. A second rule related to the HIPAA transaction standards – X12 version 5010 and NCPDP version D.0  establish earlier effective dates, with the latest being January 1, 2013.  The HIPAA transactions software must be updated to accommodate the use of the ICD-10-CM and ICD-10-PCS code sets.

To read the final rules published in the Federal Register, click the links below:

• Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards
• HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS

View the fact sheet describing both rules.

The 60-day delay in the effective dates are a requirement of the original HIPAA regulations and were set to allow Congress a chance to review the rules.  AHIMA will publish an in-depth analysis of the final rules in the coming weeks.

“The American Health Information Management Association congratulates Secretary Leavitt and the Department of Health and Human Services on the approval of final rules for adoption of ICD-10-CM and ICD-10-PCS,” said AHIMA CEO Linda Kloss in a statement to the media.  “This action will greatly improve America’s health information for years to come while bringing it into alignment with the rest of the industrial world.  It is for these and other reasons that the health information management profession is eager to help lead the American healthcare community through the immediate implementation of these 21st century diagnostic and procedural systems.”
The quest for adoption of the classification systems began almost 15 years ago.  A major step in this process was taken this past summer, when a notice of proposed rulemaking was published for the standards in August. AHIMA submitted comments on the rules in October; read the comments here.

Comments and Analysis

• Analysis of Final Rule for the Adoption of the ICD-10-CM and ICD-10-PCS Code Sets (February 2009)
• Analysis of Final Rule, January 16, 2009, Modifications to the HIPAA Electronic Transaction Standards (February 2009)
• AHIMA Comments on the Adoption of ICD-10 Classifications
• AHIMA Comments on Modifications to HIPAA Electronic Transaction Standards
• PowerPoint slides from AHIMA's National Convention Town Halls on ICD-10
• AHIMA Comments on the Nachimson Report: “The Impact of Implementing ICD-10 on Physician Practices and Clinical Laboratories”
• AHIMA's Analysis of the Proposed Rule: HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS
• AHIMA's Analysis of the Proposed Rule, August 22, 2008, Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards

As the membership association representing the largest workforce impacted by the coding system change, AHIMA is committed to providing ICD-10-CM/PCS research, advocacy, and educational opportunities, including our not-to-be-missed 2009 ICD-10 Annual Summit, April 16-17.