Medicare starts countdown to new reimbursement codes

The Centers for Medicare and Medicaid Services said Thursday the healthcare industry will have to start using new codes on October 1, 2015, when filing for reimbursement for medical procedures.

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The agency issued a rule that providers, insurance companies and others in the health industry have over a year to “ramp up their operations” and become compliant with the new codes known as International Classification of Diseases (ICD-10).

“The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers,” said the agency. “By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time.”

Many western developed countries already use the ICD-10 to help track medical statistics in their countries, but the U.S. has yet to adopt the measure and has faced legislative opposition.

The U.S. currently uses the ICD-9 system that includes 18,000 codes for various injuries and diseases. By contrast, the ICD-10 system includes 140,000 codes.

Some lawmakers have argued the system puts too much administrative burden on healthcare providers and could cost doctors tens of thousands to upgrade their systems.

While industry was preparing to start using the new system starting October 1, 2014, Congress passed the Protecting Access to Medicare Act in April, which pushed the launch date by at least a year.

CMS says since many health plans, hospitals and physician practices have already spent funds and trained staff to comply with the new codes, the one-year delay will cost them $1.1 billion to $6.8 billion.

“ICD-10 reflects the advances in medicine and medical technology that U.S. physician specialty groups called for. … [It] includes significant improvements over ICD-9-CM in coding primary care encounters, external causes of injury, mental disorders, and preventive health,” said the agency.