ICD-10: CMS Releases 'Myths and Facts'

May 20, 2013

The Centers for Medicare & Medicare Services (CMS) has once again risen in defense of its much-maligned ICD-10 diagnostic codes by issuing a revised version of a "Myths and Facts" handout.

Myth 1 has to do with the compliance date of October 1, 2014, for ICD-10 codes, which replace the ICD-9 codes now in use. CMS states that some people are under the mistaken impression that the government will give providers and insurers extra time beyond that date to switch to the new codes.

Wrong, says CMS. The Department of Health and Human Services (HHS) "has no plans to extend the compliance date for implementation." October 1, 2014, is a hard date, so healthcare providers need to "complete the steps required" to meet the deadline.

The healthcare industry has heard about hard dates for ICD-10 before, which might explain why they might be doubted. An earlier version of the "Myths and Facts" document warned that HHS had no plan to extend the compliance date beyond October 1, 2013. HHS nevertheless acted last August to move that deadline to October 1, 2014. The American Medical Association (AMA) and other medical societies had lobbied for the postponement, saying that the conversion to the more voluminous and complex set of diagnostic codes could cost medical practices tens of thousands of dollars and interfere with their adoption of electronic health records and electronic prescribing.

Other than the matter of deadlines, the revised "Myths and Facts" looks remarkably like its predecessor. As before, CMS counters the argument that the increased number of diagnostic codes in ICD-10 — 5 times the number in ICD-9 — will make the new coding system impossible to use. "Just as an increase in the number of words in a dictionary doesn't make it more difficult to use, the great number of codes...doesn't necessarily make it more complex to use," states CMS. Rather, the new codes will be handier because they are more specific, more clinically accurate, and more logically organized.

The agency also states that:

  • A number of specialty societies helped develop ICD-10, contrary to the myth that it was developed without clinical input.

  • Physicians can continue to put as many or as few ICD-10 codes on their hardcopy superbills as they wish. A bigger code set doesn't necessarily mean, as some say, that superbills have to become longer and more complex.

  • ICD-10 will not force clinicians to order medically unnecessary tests to assign a diagnostic code. As always, clinicians should code the condition to its highest degree of certainty — which may be a sign or symptom — based on the documentation in the medical record. The new code set gives clinicians more codes for signs and symptoms than ICD-9 when a definite diagnosis is elusive.

AMA Supports Bill Blocking ICD-10 Implementation

ICD-10 stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. CMS is switching from ICD-9 to ICD-10 as part of the implementation of the Health Insurance Portability and Accountability Act.

The seemingly hyperspecific and arcane nature of ICD-10 — there are codes for duck bites vs parrot bites — has provoked mockery. However, CMS says that ICD-10 is better able than ICD-9 to accommodate new diagnoses and procedures, in part because the new codes run to a maximum of 7 characters compared with 5 for the old codes. Increased specificity, says the agency, will allow a physician to indicate something as basic as whether a condition occurs on a patient's left side or right side, a level of detail not possible with ICD-9.

Despite these arguments, the AMA remains opposed to ICD-10. It supports a bill introduced last month by Rep. Ted Poe (R-TX) that would block implementation of the new codes and require a search for a less-disruptive replacement for ICD-9.

The ICD-10 "Myths and Facts" handout is available on the CMS Web site.


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