Pursuant to certain provisions of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act (HIPAA), the Department of Health and Human Services (HHS) published a
Final Rule on January 16, 2009, that mandated nationwide conversion to International Classification of Diseases, 10th Revision (ICD-10) coding from the current use of International Classification of Diseases,
Ninth Revision (ICD-9). Specifically, the Final Rule modifies the standard medical data code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting the International Classification of
Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the official ICD-10-CM guidelines for Coding and Reporting, as maintained and distributed by HHS, and the International
Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, as maintained and
distributed by HHS. These new codes replace ICD-9-CM, Volumes 1 and 2, including the Official ICD-9-CM Guidelines for Coding and Reporting and the ICD-9-CM Volume 3, including the Official ICD-9-CM Volume 3
Guidelines for Coding and Reporting for diagnosis and procedure codes, respectively.
In January 2009, HHS mandated October 1, 2013 as the single compliance date where all covered entities must begin using the ICD-10 code set.
Since then, HHS published a Final Rule on September 5, 2012, officially changing the ICD-10 compliance date to October 1, 2014. This means that any service or encounter that occurs on or after
October 1, 2014 must be coded using ICD-10 codes.
On August 4, 2014, the Department of Health and Human Services (HHS) issued a Final Rule establishing October 1, 2015 as the compliance date for ICD-10
code set. The Final Rule also requires continued use of the International Classification of Diseases, 9th Revision (ICD-9) through September 30, 2015. These
regulations are effective 30 days after publication to the Federal Register. Providers, insurance companies, and others in the healthcare industry can now focus
their efforts on the finalized deadline and concentrate on moving toward industry readiness together for October 1, 2015.
Please use the following link to view the Final Rule:
ICD-10-CM and ICD-10-PCS
ICD-10-Clinical Modification (CM)
ICD-10-Procedure Coding System (PCS)
Terminology changes in ICD-10-PCS
There will be several definition and terminology changes in the conversion, such as:
ICD-9 Procedure Term
ICD-10 Procedure Term
Extraction of Products of Conception
Resection of Tonsils
ICD-9-CM vol. 1 & 2 and ICD-10-CM Comparison
ICD-9-CM Diagnosis Codes
ICD-10-CM Diagnosis Codes
3-5 characters in length
3-7 characters in length
Approximately 13,000 codes
Approximately 68,000 available codes
First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric
First digit is alpha; Digits 2-3 are numeric; Digits 4-7 are alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Example: 453.41 Venous embolism and thrombosis of deep vessels of proximal lower extremity
Example: I82.411 Embolism and thrombosis of right femoral vein
ICD-9-CM vol. 3 and ICD-10-PCS Comparison
ICD-9-CM Procedure Codes
ICD-10-PCS Procedure Codes
3-4 numeric characters in length
7 alpha-numeric characters in length
Approximately 3,000 codes
Approximately 87,000 available codes
Based upon outdated technology
Reflects current usage of medical terminology
Lacks body site laterality
Has body site laterality
Generic terms for body parts
Detailed descriptions for body parts
Lacks description of methodology and approach for procedures
Provides detailed descriptions of methodology and approach for procedures
Limits DRG usage
Allows DRG definitions to better recognize new technologies and devices
Lacks precision to adequately define procedures
Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information.
Example: 47.01- Laparoscopic appendectomy
Example: 0DTJ4ZZ - Laparoscopic appendectomy
More information on ICD-10
For questions regarding the MHS ICD-10 implementation, please contact HIPAATCSImail@dha.mil.
TRICARE Network or Non-network Providers: For questions on ICD-10 implementation, please contact your appropriate Regional Contractor.
Military Health System (MHS) Links
Centers for Medicare and Medicaid Services (CMS) Links
Other Healthcare Industry ICD-10 Links
* For TRICARE HIPAA Privacy and Security pages, please click here.
“On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."
7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042-5101
The appearance of hyperlinks to external Web sites does not constitute
endorsement by the Defense Health Agency of these Web sites or the
information, products or services contained therein. For other than
authorized government activities. The Defense Health Agency does not
exercise any editorial control over the information you may find at other
locations. Such links are provided consistent with the stated purpose of
this DoD Web site. Accessibility/Section 508