Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced a final rule that provides a one-year delay, from October 1, 2013 to October 1, 2014, in the compliance date for use of new ICD-10 codes. These code sets, officially known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.

Back in 2009 the Secretary of HHS adopted the ICD-10-CM and ICD-10-PCS (ICD-10) code sets as the HIPAA standards to replace the previously adopted ICD–9–CM Guidelines for Coding and Reporting. The compliance date set by the final rule was October 1, 2013.

Since that time, some provider groups have expressed strong concern about their ability to meet the 2013 compliance date and the serious claims payment issues that might ensue if they do not meet the date. Some providers’ concerns about being able to meet the ICD-10 compliance date are based, in part, on difficulties they had meeting the compliance deadline for the adopted Associated Standard Committee’s (ASC) X12 Version 5010 standards (Version 5010) for electronic health care transactions. Compliance with Version 5010 and ICD-10 by all covered entities is essential to a smooth transition to the updated medical data code sets, as the failure of any one industry segment to achieve compliance would negatively affect all other industry segments and result in returned claims and provider payment delays.

The Centers for Medicare and Medicaid Services (CMS) believes the change in the compliance date for ICD-10 gives covered health care professionals and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition.

More information on the final rule is available in a fact sheet at http://www.cms.gov/apps/media/fact_sheets.asp.

NCMS offers a wealth of resources on the transition to ICD-10 here.