September 26, 2012

Meeting Reveals Compromise on New ICD-10 Date Took a Great Deal of Work

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It took just 30 minutes for four members of the ICD-9-CM Coordination and Maintenance Committee (the Committee) to provide ICD-10 updates at its Sept. 19, 2012, meeting—thanks, in large part, to the partial code freeze now in effect for ICD-9 and ICD-10 and the delayed implementation date for ICD-10 of Oct. 1, 2014.

 

Patricia Brooks, RHIA, senior technical advisor for the Centers for Medicare & Medicaid Services’ (CMS) hospital and ambulatory policy group and co-chair of the ICD-9-CM Coordination and Maintenance Committee, congratulated Denise Buenning, acting deputy director of CMS’s Office of E-health Standards & Services (OESS), and her staff on the “thorough and conscientious” job they did in their evaluation of the ICD-10 implementation process details leading to the date change. She noted the “challenges” they faced, including deciding upon the final Oct. 1, 2014, go-live date, which was “a compromise that took a great deal of work.”

Buenning agreed that it was a challenge, explaining that her and her team reviewed and analyzed hundreds of public comments that “went all over the spectrum,” saying that it was like “when you have 10 people in the room and you get 11 opinions.”

She reiterated that CMS’s rationale for deciding on the one-year delay resulted partially from the provider community’s feedback on its lack of readiness for the 5010 implementation. This reality made the agency realize that “getting them ready for ICD-10 would be an ongoing challenge,” and the extra time gives the industry, as well as CMS, to “dig a little deeper” into what needs to be included in its plans.

“We’re making progress, and our goal is to use the next year to work on our implementation and make sure it’s complete,” said Buenning, noting that during the next year CMS also plans to “push out tools,” such as checklists and decision trees, for providers. Between October 2013 and the Oct. 1, 2014, implementation date, the agency will focus on testing and on answering questions like the following: What does readiness mean? What does end-to-end testing mean?

Deadlines of Partial Freeze

 

Brooks launched the meeting by reminding members of the public who attended, or listened to, the meeting that the Committee does not make the final decisions about topics discussed. Instead, it submits recommendations to CMS and the Centers for Disease Control (CD) and Prevention, which ultimately make the final decisions.

However, the Committee did previously implement a partial freeze of the ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes, which will end one year after the Oct. 1, 2014, ICD-10 implementation date. As a result of this freeze, very few code change requests were on the Sept. 19 agenda. For those who haven’t heard, here’s the rundown related to the partial freeze:

  • The last regular, annual updates to both ICD-9-CM and ICD-10 code sets were made on Oct. 1, 2011.
  • On Oct. 1, 2012, Oct. 1, 2013, and Oct. 1, 2014, only limited updates will be made to code sets to capture new technologies and diseases.
  • On Oct. 1, 2014, no updates will be made to ICD-9-CM since it will no longer be used for reporting.
  • On Oct. 1, 2015, regular updates to ICD-10 will begin.
  • Other important deadlines include the following:
  • Oct. 1, 2012: New and revised ICD-9-CM codes go into effect along with DRG changes.
  • Nov. 16, 2012: Deadline for receipt of public comments on proposed code revisions discussed at the Sept. 19, 2012, Committee meeting, which would be implemented on Oct. 1, 2013.
  • Jan. 4, 2013: Deadline for members of the public requesting that topics be discussed at the March 4–5, 2013, Committee meeting must have their requests to CMS for procedures and to the National Center for Health Statistics for diagnoses.

Available Resources

Brooks encouraged providers to take advantage of CMS’s free national provider calls (NPCs), which are designed to prepare the industry for the change to the ICD-10 medical coding system. All NPCs are free of charge but registration is required to participate live. The next one, which is scheduled for Oct. 25, 2012, will focus on preparing physicians for the implementation of ICD-10. A practicing physician will share advice on how her hospital is educating physicians about the importance of coding and ICD-10 fundamentals.


Other past calls of interest include:

  • ICD-10 Implementation Strategies and Planning (Nov. 17, 2011)
  • Basic Introduction to ICD-10-CM (March 23, 2010)
  • ICD-10-CM/PCS Medicare Severity DRG Conversion  (Nov. 19, 2009)

The above information and links to previous provider calls can be found at http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html.

MS-DRG Conversion Project

Vendors are, apparently, very happy about the fact that version 30 of the ICD-10 MS-DRG Definitions Manual will be available in November 2012—that is, at least what Committee member Mady Hue reported.

By early 2013, mainframe and PC version of v30 ICD-10 MS-DRG software will be available through the National Technical Information Service (NTIS).  This update includes the following:

  • Changes outlined in the “Summary of Changes” document for ICD-10 MS-DRG v29
  • All logic changes for ICD-9 MS-DRG v30 published in the fiscal year (FY) 2013 inpatient prospective payment system (IPPS) final rule
  • Addition of new FY2013 ICD-10 diagnoses and procedure codes
  • Removal of deleted FY2013 ICD-10 diagnoses codes
  • Changes based on evaluation of comments sent to CMS
  • Changes based on internal and BETA site review

The 2013 ICD-10-PCS Reference Manual also has been reformatted and updated (and is available at http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html).

As described at the following website, this is a project for using the general equivalence mappings (GEMs) to convert the draft MS-DRGs v29.0 to ICD-10-CM and ICD-10-PCS. For more on this, go to http://www.cms.gov/Medicare/Coding/ICD10/ICD-10-MS-DRG-Conversion-Project.html.

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Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.