Regulators get industry guidance for the future of ICD-10 updates

The National Committee on Vital and Health Statistics is suggesting recommendations to simplify adoption of future code sets and standards.

NCVHS, a public advisory body to the Department of Health and Human Services, is offering ideas for changes that would affect adoption of future versions of the code sets and related health terminology and vocabulary standards.

The HIPAA law requires HHS to review adopted standards and make modifications when appropriate, but not more frequently than annually to avoid disruptions and costs of compliance within the industry. Consequently, NCVHS has identified three recommendations for the government regarding ICD-10 version updates.

To start, HHS should use sub-regulatory processes to make ICD-10 updates in the same way it handles updates to all other HIPAA code sets, the committee advises regulators.

The World Health Organization approved ICD-10 in 1990, and the United States started using it for mortality reporting in 1999; then, it made modifications for morbidity classification, and NCVHS recommended adoption in 2003.

But there has only been one update to ICD since HIPAA code set standards were put in place and that was in 2015, when the healthcare industry transitioned from ICD-9 to ICD-10, NCVHS notes. “The timeline and experience of this update illustrates why the process must be simplified.”

Consequently, the organization recommends HHS use sub-regulatory processes to make version updates to ICD in the same way it handles updates to all other named HIPAA code set standards.

In the second recommendation, NCVHS believes HHS should soon invest in a project to evaluate ICD-11 and develop a plan that will enable a smooth and transparent transition at an optimal time. The World Health Organization will adopt ICD-11 in May.

“This, in turn, starts the clock ticking on a series of critical decisions for the U.S., such as when ICD-11 should replace ICD-10 for cause of death coding; whether ICD-11 includes sufficient detail to meet U.S. needs for morbidity classification without a clinical modification; the cost-benefit of a version update; and assessing optimal timing of an update considering other standards updates,” ” according to NCVHS.

With this recommendation, NCVHS urges the Secretary to provide the leadership and resources needed to begin this complex evaluation sooner rather than later.

Also See: AMA board to members: Skipping ICD-10 for ICD 11 not recommended

For its third recommendation, NCVHS calls on HHS to clarify that IDC-10-PCS is completely separate from ICD-10 and will not be updated with the transition of ICD-10 to ICD-11.

“ICD-10-PCS is a procedure classification system designed by CMS for coding hospital-based procedures. This development was undertaken because the WHO retired its procedure coding system with the tenth revision of ICD. The ICD rubric was attached to the new U.S. system presumably to make it clear that this system replaced the earlier ICD version. However, it is not a WHO-developed or maintained vocabulary. Updates to the U.S. procedure classification system do not need to be tied to updates to ICD and vice versa.”

Overall, the three recommendations address critical near-term administrative simplification code set issues, according to NCVHS, and the organization gave HHS and stakeholders some closing tips.

“Initiating an ICD evaluation and adoption plan will avoid the costly and highly disruptive migration in the transition from ICD-9 to ICD-10, the impact of which was experienced across the industry for several years. NCVHS is eager to avoid this from occurring in the future and to support you as you move these issues forward.”

The full report is available here.