October | November - Missouri Optometric Association

October | November 2008
HHS Proposes Adoption
of ICD-10 Code Sets and
Updated Electronic Transaction
Standards
by Rich Wilson
According to HHS, the proposed new diagnoses
codes, ICD-10, are designed to improve disease
tracking and speed transition to an electronic
health care environment. The new codes will
become effective October 1, 2011, and will
greatly expand the number of codes; allowing
for quality reporting, pay-for-performance, biosurveillance,
and other critical activities.
In 2000 the ICD-9 codes, under authority
provided by the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), code
sets were adopted for use in the administrative
transactions by both the public and private
sectors to report diagnoses and inpatient hospital procedures. Covered entities
required to use the ICD-9-CM code sets include health plans, health care
clearinghouses, and health care providers who transmit any electronic health
information in connection with a transaction for which a standard has been adopted
by HHS.
Having been developed three decades ago, ICD-9 is now viewed as outdated
because of its limited ability to accommodate new procedures and diagnoses. ICD-9
contains only 17,000 codes and is expected to start running out of available codes
next year. In contrast, the ICD-10 code sets contain more than 155,000 codes and
accommodate a host of new diagnoses and procedures. The additional codes will
help to enable the implementation of electronic health records because they will
provide more detail in the electronic transactions.
Implementing these new codes will cost practices money for software changes,
training, and lost revenue while learning how to use the new system. Cost
estimates are divided by the size of the practice: A typical “small” practice is
comprised of three physicians and two impacted administrative staff, a typical
“medium” practice is comprised of 10 providers, one full-time coder, and six
impacted administrative staff, and a typical “large” practice, comprised of 100
providers, with 64 coding staff comprised of 10 full-time coders and 54 impacted
medical records staff.
10
Continued, see HHS page 21