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Defense Health Agency

"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."

International Classification of Diseases - 10th Revision (ICD-10)

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.

ICD-10 Compliance

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: https://www.federalregister.gov/articles/2014/08/04/2014-18347/administrative-simplification-change-to-the-compliance-date-for-the-international-classification-of

ICD-10-CM and ICD-10-PCS

ICD-10-Clinical Modification (CM)

  • Used for diagnosis coding in all health care settings for reporting conditions, symptoms and diseases for data collection, payment policy, research, and other purposes
  • Developed by the National Center for Health Statistics under authorization of World Health Organization (WHO).

ICD-10-Procedure Coding System (PCS)

  • Used for procedure coding in the inpatient hospital setting
  • Developed by the Centers for Medicare and Medicaid Services (CMS)

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

Amputation

Detachment

Aspiration

Drainage

Cesarean Section

Extraction of Products of Conception

Tonsillectomy

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

Lacks detail

Very specific

Lacks laterality

Has laterality

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-10-CM Format

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

Limited space for adding new codes

Flexible for adding new codes

Lacks detail

Very specific

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

ICD-10-PCS Format

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

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