ICD-10

The International Classification of Disease (ICD)-10 code sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers. ICD-10 also includes significant improvements over ICD-9 in coding primary care encounters, external causes of injury, mental disorders, and preventive health. The ICD-10 code sets’ breadth and granularity reflect advances in medicine and medical technology, as well as capture added detail on socioeconomics, ambulatory care conditions, problems related to lifestyle, and the results of screening tests.

As a result, medical terminology and disease classifications are being updated to be consistent with current clinical practice per regulations at 45 CFR Part 162. All Centers for Medicare & Medicaid Services (CMS) ICD-10 system changes have been phased-in and are scheduled for completion by October 1, 2014, giving a full year for additional testing, fine-tuning, and preparation prior to full implementation of ICD-10 CM/PCS for all Health Insurance Portability and Accountability Act (HIPAA)-covered entities. ICD-10-CM/PCS will replace ICD-9-CM/PCS diagnosis and procedure codes in all health care settings for dates of service, or dates of discharge for inpatients, that occur on or after the implementation date of ICD-10.

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The Coverage and Analysis Group at CMS is the Federal entity that oversees National Coverage Determination (NCD) and Local Coverage Determination (LCD) policies. NCDs and LCDs constitute Medicare coverage decisions made by CMS and applied both nationally and locally across all health insurance payers. In light of HIPAA as it relates to ICD-10, CMS is responsible for converting the ICD-9 codes to ICD-10 codes in NCDs and LCDs as the Agency finds appropriate. There are approximately 330 NCDs spanning a range of time and not all NCDs are appropriate for translation. CMS has determined which NCDs/LCDs should be translated and is in the process of completing the associated systems changes. CMS change request (CR) transmittals and Medicare Learning Network Articles (MLN Matters®) are the vehicles used to communicate information regarding NCD/LCD translations.

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The table below contains the various CRs and associated documents that CMS/CAG has issued to date as part of its ICD-10 conversion activities related to NCDs. It will be updated periodically. For more in depth information related to the contents of the table, please contact: Pat Brocato-Simons, [email protected], 410-786-0261.

The information below is for translations of NCDs. If you have questions about translations of LCDs, please contact your Medicare Administrative Contractor. The contact information can be found here.

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