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BOWMAN, CLELAND, AND STAGGS
FIGURE 1. ICD-10 Legislative Timeline
Abbreviations: ICD, International Classification of Disease; CMS, Centers for Medicare & Medicaid Services; CM, clinical modification; CPT/HCPCS, Current Procedural Terminology/Healthcare
Common Procedure Coding System; PCS, procedural coding system.
has not been paid for at least 90 days; at least 25% of their
patients are on Medicare; or at least 25% of their reimbursements
are from Medicare.
The Protecting Access to Medicare Act of 2014, implemented
on April 1, 2014, includes a provision that the Secretary of the
U.S. Department of Health and Human Services may not
adopt ICD-10 before October 1, 2015. 3 Nevertheless, not everyone
was in favor of another delay in ICD-10 implementation.
The American Hospital Association, most of the
national payers, and the American Academy of Professional
Coders lobbied against another delay.
Absent another delay, effective October 1, 2015, ICD-
10-CM will replace ICD-9 as a HIPAA-named code set to be
used on electronic, paper, fax, and phone transactions by
HIPAA-covered entities, which include providers, payers,
health care clearinghouses, software vendors, and thirdparty
billing services. Furthermore, ICD-9-CM will not be
KEY POINTS
The International Classification of Disease (ICD) is used
globally to identify health trends and statistics.
In 1994, the World Health Organization adopted the 10th
revision of the ICD, ICD-10.
Despite the advantage of more precise coding under ICD-
10, the United States has delayed adoption of the code set
several times.
The transition from the current ICD-9 code set to ICD-10 is
a major undertaking that will require significant resources.
Careful systematic planning is necessary to minimize costly
disruptions and errors during the transition.
maintained after implementation of ICD-10-CM, thus noncovered
entities will also likely transition to ICD-10.
CREATING AND MAINTAINING A HOLISTIC ICD-10
READINESS PROGRAM
No matter if a practice is a fıve-physician oncology clinic or a
100-plus multispecialty physician group, a holistic approach
to ICD-10 preparation is essential. For example, if a health
system is focused primarily on application readiness, then issues
would occur with lack of staff knowledge, workflow,
gaps in clinical documentation, mitigation of payer risk, and
care team overall readiness.
Below are examples of work streams that would be part of a
holistic remediation approach we will describe in the following
sections:
• Communication and engagement
• Application remediation and testing
SIDEBAR. ICD-10-CM versus ICD-10-PCS
ICD-10-CM (Clinical Modification)
The diagnosis code set that will replace ICD-9-CM volumes 1
and 2 and will be used by all providers in every health care
setting
Current Procedural Terminology/Healthcare Common Procedure
Coding System (CPT/HCPCS) will still be used for outpatient
and physician office procedures.
ICD-10-PCS (Procedural Coding System)
The code set of hospital inpatient procedures that will replace
ICD-9-CM volume 3.
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2015 ASCO EDUCATIONAL BOOK | asco.org/edbook