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Home Health Coding: The Real Reason for ICD-10-CM

Posted by Steven Steggles on Nov 28, 2016

There have been delays…

Like the rest of the planet, Home health EMRs and other home health consultants have implement ICD-10-CM. On January 16, 2009, the Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 as of October 1, 2013 for home health coding. In February 2013, HHS announced it was considering delaying the compliance date again due to feedback from the home health care coding industry, including from the AMA. On September 5, 2013 HHS published a regulation that pushed back the compliance date one year to October 1, 2015, in part due to concerns about meeting the 2014 deadline given several other competing deadlines providers must meet.

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Home care coding on or after October 1, 2015 now use the ICD-10 codes. The regulation names ICD-10-CM for reporting diagnoses in all clinical situations. CPT and HCPCS will continue to be the code sets for reporting procedures in outpatient and office settings.

Because ICD-10 has replaced ICD-9 as a HIPAA-named code set, covered entities, defined in HIPAA as health care providers, including home health agencies are required to comply with the regulation. Although HIPAA requirements specifically apply to the HIPAA-named electronic transactions, payers (Medicare, Medicaid etc) are expected to require ICD-10 codes on transactions submitted using other methods, such as on paper (e.g., 1500 claim form), through a dedicated fax machine, or via the phone.

CMS is the agency within HHS that is responsible for oversight of the implementation and compliance with the regulation. Additional resources are available on the CMS website:www.cms.gov/ICD10/.

ICD-9 became outdated…

While there were many providers who believe the implementation of ICD-10 is unnecessary and burdensome, there were other physicians and industry stakeholders who believe that the ICD-9 code sets have become too outdated and are no longer workable for treatment, reporting, and payment processes today. ICD-9 has been used widely in the U.S. since 1978. The World Health Organization (WHO) endorsed ICD-10 in 1990 and many countries have adopted versions of it.

he age of ICD-9 means that it does not accurately reflect all advances in medical technology and knowledge. The ICD-9 diagnosis codes are divided into chapters based on body systems.

We ran out of codes in ICD-9

During the years of maintaining and expanding the codes within Chapters, the more complex body systems ran out of codes. The lack of codes within the proper chapter has resulted in new codes being assigned in chapters of other body systems. For example, new cardiac disease codes were assigned to the chapter for diseases of the eye. The rearranging of codes made finding the correct code more complicated.

ICD-9 Didn’t Meet Medical Advances

Another driver for replacing ICD-9 was the increased specificity of ICD-10. It is believed that the more specific data will provide better information for identifying diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events and home health coding certification. The more precise codes also have the potential benefit for fewer rejected claims, improved benchmarking data,improved quality and care management, and improved public health reporting.

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