From ICD-9-CM’s implementation in 1979 to ICD-10’s release by the World Health Organization in 1993, ICD codes have evolved significantly over the years. Read the timeline in its entirety to learn more about the development and implementation of ICD-10.
ICD-9-CM is implemented (prior to development and implementation of reimbursement systems that rely on diagnosis and procedure codes)
Although the annual update process allows some addition of new conditions and procedures, and expansion for greater detail, it uses as its base a classification system that was developed nearly 40 years ago.
Implementation of a hospital inpatient prospective payment system which uses ICD-9-CM diagnosis and procedure codes as the basis for assigning cases to DRGs.
The National Committee on Vital and Health Statistics (NCVHS) issues a report to the Assistant Secretary for Health noting that while the ICD-9-CM classification system has been responsive to changing technologies and identifying new diseases that impact heavily on the community, there is concern that the ICD classification might be stressed to a point where the quality of the system would soon be compromised.
NCVHS sends a letter to Assistant Secretary for Health and Administrator of the Healthcare Financing Administration (HCFA) recommending that the Department of Health and Human Services (HHS) dedicate resources to determine the feasibility of implementing ICD-10 for morbidity applications.
ICD-10 is released by the World Health Organization.
NCVHS sends a letter to the Assistant Secretary for Health urging HHS to consider the desirability and feasibility of developing a clinical modification of ICD-10 for morbidity purposes.
The National Center for Health Statistics (NCHS) awards a contract to the Center for Health Policy Studies to evaluate ICD-10 for morbidity purposes within the U.S. A prototype of ICD-10-CM is developed following a thorough evaluation of ICD-10 by a Technical Advisory Panel comprised of private and public sector stakeholders.
HCFA announces plans to initiate a solicitation for a contract to develop a new procedure coding system for use with hospital inpatients to replace the ICD-9-CM procedure codes. This new system is referred to as ICD-10-PCS.
Further work on ICD-10-CM is undertaken by NCHS, including a thorough review of ICD-9-CM Coordination and Maintenance Committee proposals for modifications that could not be incorporated into ICD-9-CM and extensive collaboration with many medical/surgical specialty groups.
HCFA awards a contract to 3M Health Information Systems to develop the procedure classification system to replace Volume 3 of ICD-9-CM (hospital inpatient procedures), known as ICD-10-PCS. It is developed using an open process and a Technical Advisory Panel provides review and comments throughout development. The new procedure classification adheres to the criteria established by NCVHS for a procedure classification system in 1993.
Informal and formal testing of ICD-10-PCS is conducted.
The draft of the Tabular List of ICD-10-CM, and the preliminary crosswalk between ICD-9-CM and ICD-10-CM is made available on the NCHS website for public comment during a three-month open comment period, which begins December 1997 and ends February 1998. More than 1,200 comments are received from 22 individuals and organizations representing a variety of groups, including one governmental agency, two research institutions, three information system developers, four professional organizations, and several health care providers. Comments range from general observations to very specific and detailed analyses.
More than eight days of hearings are held by NCVHS with letters and written and oral testimonies provided by more than 80 public and private sectors groups representing the healthcare industry, the Federal and State governments, public health and research communities, insurers, and providers.
The Notice of Proposed Rulemaking (NPRM) for Transactions and Code Sets is published by the HHS, as required by the Health Insurance Portability and Accountability Act of 1996. ICD-9-CM is proposed as the initial standard for diagnoses and inpatient procedures. The NPRM includes the following language: “In addition to accommodating the initial code sets standards for the year 2000, those that produce and process electronic administrative health transactions should build the system flexibility that will allow them to implement different code formats beyond the year 2000.”
The ICD-10-PCS coding system, training material and crosswalk to ICD-9-CM procedure codes is posted on the Centers for Medicare and Medicaid Services (CMS) web site. The coding system and related materials have been updated annually since then.
ICD-10 is implemented in the U.S. for mortality reporting.
An overview of the comments received during the ICD-10-CM comment period is posted on the NCHS website in 1999. A summary of the comments also is presented at the November 1999 ICD-9-CM Coordination and Maintenance Committee meeting and posted on NCHS website.
The Final Rule for Transactions and Code Sets is published and states: “ICD-10-CM has great potential for replacement of ICD-9-CM.”
Further enhancements are made to ICD-10-CM continue with changes being made in response to the open comment period, as well as, input from physician specialty groups.
In the Benefits Improvement and Protection Act of 2000, Congress addresses requirements for incorporation of new medical services and technologies into the Medicare hospital inpatient prospective payment system. In the September 7, 2001 issue of the Federal Register, CMS notes the limitation of ICD-9-CM regarding the ability to expeditiously incorporate new medical services and technologies into the classification. A number of procedural approaches and techniques cannot be readily captured by the structure of ICD-9-CM codes.
CMS states a contract had been awarded to 3M HIS to undertake the DRG conversion necessary when ICD-10-CM and ICD-10-PCS are adopted as national standards.
An updated draft of ICD-10-CM is posted on the NCHS web site.
Under the direction of NCVHS, a contract is awarded to RAND’s Science and Technology Policy Institute to conduct an impact analysis on moving to ICD-10-CM and ICD-10-PCS. This analysis concludes that switching to the new code sets is likely to generate more benefits than costs.
The American Health Information Management Association (AHIMA) and the American Hospital Association (AHA) jointly conduct a pilot test of ICD-10-CM during June/July 2003. The study involves dual coding records in ICD-9-CM and ICD-10-CM. More than 6100 records from a broad cross section of health care community were dual coded by 180+ participants. The results indicate that: there is general support for adoption of ICD-10-CM; ICD-10-CM is seen as an improvement over ICD-9-CM; and ICD-10-CM is more applicable to non-hospital settings than ICD-9-CM.
In November 2003, the NCVHS sends a letter to the Secretary of HHS recommending adoption of ICD-10-CM and ICD-10-PCS as HIPAA standards for national implementation to replace current uses of ICD-9-CM.
ICD-10-CM is updated annually every October 1 to accommodate changes made to ICD-10 by the World Health Organization and to incorporate changes made to ICD-9-CM diagnosis codes. ICD-10-PCS is updated annually every October 1 to incorporate changes made to ICD-9-CM, Volume 3.
The NCVHS Workgroup on Quality report titled “Measuring Health Care Quality: Obstacles and Opportunities” notes that adoption of ICD-10-CM would help with the capture of more specific clinical information on disease severity, including complications, co-morbidities and risk factors. The report recommends adoption of ICD-10-CM.
Subcommittee on Health of House Ways and Means Committee addresses adoption of ICD-10-CM and ICD-10-PCS as part of a hearing on the use of health information technology.
Representative Nancy Johnson (CT) introduces H.R. 4157, the “Health Information Technology Promotion Act of 2005,” requiring the replacement of ICD-9 with ICD-10 for transactions occurring on or after October 1, 2009. The intent of this section of the bill is to speed up the implementation of ICD-10-CM/PCS. This section was ultimately removed because HHS agreed to move forward with the regulatory process to implement ICD-10-CM/PCS.
Subcommittee on Health of House Ways and Means Committee holds hearing on the adoption of ICD-10-CM and ICD-10-PCS.
Senator Norm Coleman (MN) introduces S. 628, the “Critical Access to Health Information Technology Act of 2007,” requiring the replacement of ICD-9 with ICD-10. The ICD-10 language called for a final rule to be promulgated by October 1, 2008, with full implementation by October 1, 2011.
NCVHS sends a letter to the Secretary titled, “Revision to HIPAA Transaction Standards Urgently Needed.” The letter states that “…there are specific and urgent business drivers (e.g., the need to accommodate ICD-10 codes) that justify adoption of Version 5010.
In a letter to the Secretary on “Quality measurement and public reporting in the current health care environment”, NCVHS recommends that the HHS “Accelerate US adoption of ICD-10-CM and ICD-10-PCS by publishing the required notice of proposed rulemaking.”
HHS publishes a Notice of Proposed Rule Making (NPRM) for replacement of ICD-9-CM by ICD-10-CM and ICD-10-PCS on October 1, 2011.
HHS publishes a final rule for adoption of ICD-10-CM and ICD-10-PCS on October 1, 2013.
NCVHS conducts a hearing to monitor industry progress on implementation of updated versions of the HIPAA transaction standards and ICD-10 code sets. Following the hearing, the Committee sends a letter to the Secretary recommending that HHS, “Reiterate in every publication, presentation and public forum, that the deadline for Versions 5010, D.0 and 3.0 is January 1, 2012, and the deadline for implementation for ICD-10 code sets is October 1, 2013. These deadlines have been established by HHS as the law, and there is no justification for changing them. HHS, through CMS, must effectively publicize its commitment to the compliance dates.”
CMS announces a partial code set freeze in preparation for the ICD-10 transition, resulting in the last regular annual update to ICD-9-CM and ICD-10-CM/PCS occurring on October 1, 2011 with only limited code updates to capture new technology and new diseases being implemented until the resumption of regular updates one year after the ICD-10 transition.
NCVHS holds another hearing to monitor industry progress on implementation of updated versions of the HIPAA transaction standards and ICD-10 code sets and again recommends to the HHS that “HHS should use all communication vehicles to reiterate and emphasize that the compliance dates for implementing 5010/D.0/3.0 and ICD-10 code sets are not changing.”
NCVHS sends a letter to HHS Secretary urging that any delay in ICD-10 implementation not be more than a year, due to the significant financial burden that accrues with each month of delay.
HHS publishes an NPRM to change the compliance date for ICD-10-CM/PCS from October 1, 2013 to October 1, 2014.
NCVHS holds a hearing on the industry status of planning, transitioning and implementation of administrative transaction standards, code sets and operating rules.
HHS publishes a final rule that changes the compliance date for ICD-10-CM/PCS from October 1, 2013 to October 1, 2014.
NCVHS holds a hearing on current state of administrative simplification standards, code sets and operating rules.
The “Cutting Costly Codes Act,” H.R. 1701 and S. 972, is introduced by Representative Ted Poe (TX) and Senator Tom Coburn (OK), which would prohibit implementation of ICD-10-CM/PCS on October 1, 2014.
Congress passes bill H.R. 4302 to patch the Sustainable Growth Rate (“SGR” or “Doc Fix”). The bill, signed into law on April 1, 2014, delays ICD-10 implementation until October 2015 at the earliest.
In a proposed rule published in April 2014, CMS indicates its intent to publish a final rule setting October 1, 2015 as the new ICD-10 implementation date.
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Read “Misperceptions, Misinformation, and Misrepresentations: The ICD-10-CM/PCS Saga” originally published in the Journal of AHIMA.