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Diagnosis: Don't Delay — CMS Says U.S. Must Catch Up with World on ICD-10

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When colleagues go before the World Health Organization (WHO), the fact that the United States is the only country without the modern diagnostic coding system known as ICD-10 causes some chagrin, according to Denise Buenning, of the Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services (HHS). 

“Don’t wait, start your planning,” Buenning told insurers and state regulators meeting on the medical loss ratio quality improvement subgroup committee Wednesday outside Washington, at the fall meeting of the National Association of Insurance Commissioners (NAIC). “We don’t want delays.”

Buenning, who is director of the Administrative Simplification Group of the Office of E-Health Standards and Services at CMS, recommended training staff in the coding classification six months before implementation, or in April 2013. She also strongly encouraged insurers and regulators to participate in educational forums on the subject, whether through travel or hosted webinars. 

Buenning said it was too soon to tell if there would be any delay in the October 2013 implementation date of ICD-10, telling National Underwriter that insurers have “known for awhile” that this transition to ICD-10 from ICD-9 was happening. The shift was first proposed in 2008, with an effective date of October 2011. Insurers got two additional years, so they are now supposed to be ready by 2013.

Larger health organizations are in the beginning or planning stages of implementation, but smaller groups have more of a struggle, as this is an unfunded mandate, Buenning noted during and after her presentation. 

Before implementation can be done, however, the software upgrades known as Version 5010 must be completed. Version 5010 refers to a revised set of HIPAA transaction standards. All covered by the Health Insurance Portability and Accountability Act of 1996 must transition to 5010 by Jan. 1, 2012, according to CMS.

ICD-10 is the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, a comprehensive list for the coding of diagnoses of all types and circumstances maintained by the World Health Organization (WHO) and endorsed by the 43rd World Health Assembly in May 1990. The 10th Revision was adopted by WHO member states in 1994, according to WHO. 

WHO says the classification is the latest in a series which has its origins in the 1850s. The first edition was adopted by the International Statistical Institute in 1893. WHO took responsibility for the ICD in 1948, when the 6th Revision, which included causes of morbidity for the first time, was published.