CMS Posts 2012 ICD-10-CM Code Update
CMS has posted the 2012 ICD-10-CM code updates (which are replacing the ICD-9-CM diagnosis codes) on its website. CMS previously released the 2012 ICD-10-PCS (procedure) files.
CMS Resources on Transitions to HIPAA 5010 Transaction Standards/ICD-10
CMS has compiled resources for the health care industry as they prepare for the transitions to Version 5010 HIPAA electronic health transactions standards on January 1, 2012 and the ICD-10 for medical diagnosis and inpatient procedure coding on October 1, 2013. Most recently, CMS has released a series of “Implementation Handbooks” to assist small and medium provider practices, large provider practices, small hospitals, and payers with the transition to ICD-10.
CMS Transmittal on 2012 Update to DMEPOS Fee Schedule
CMS has issued instructions on the CY 2012 update to the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule. Among other things, the transmittal provides for a 2.4% increase to the DMEPOS fee schedule; updates the gap-filling methodology for pricing of new DMEPOS; and provides instructions related to codes and modifiers, DMEPOS competitive bidding product category codes, and pricing updates.
Update: The fee schedule files are now available.
CMS Releases 2012 HCPCS Update
Today CMS released the 2012 update to the Healthcare Common Procedure Coding System (HCPCS) files. The files include the Level II alphanumeric HCPCS procedures and modifiers, long and short descriptions, and other related data.
CMS Call on ICD-10 Implementation Strategies and Planning (Nov. 17)
CMS is hosting a National Provider Call on "ICD-10 Implementation Strategies and Planning” on November 17, 2011. The call will include presentations by representatives from CMS, the American Hospital Association, the American Health Information Management Association, and the Centers for Disease Control and Prevention. The session will address, among other things: general ICD-10 requirements and CMS implementation planning; Coding Clinic for ICD-10/AHA's implementation plans; provider and vendor readiness; public health reporting issues; and Medicare claims processing guidance for implementing ICD-10. Registration is required.
CMS Call on SNF PPS MDS 3.0 and RUG-4 (Nov. 3)
On November 3, 2011, CMS is hosting a National Provider Call on "Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Minimum Data Set (MDS) 3.0 and Resource Utilization Group-Version 4 (RUG-IV) Policies and Clarifications.” CMS will provide a brief overview of the policies, along with clarifications on FY 2012 SNF PPS policies related to the MDS 3.0. The call will cover: Allocation of group therapy; Changes to the MDS Assessment Schedule; End of Therapy Other Medicare Required Assessment (OMRA) Clarifications; End Of Therapy with Resumption; and Change of Therapy (COT) OMRA. A question and answer session will follow the CMS presentations. Registration is required to participate in the call.
CMS Provider Call on Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions (Aug. 31)
On August 31, 2011, CMS is hosting a national education call regarding Medicare fee-for-service implementation of HIPAA Version 5010 and D.0 transaction standards. The registration deadline for the call is 2 pm EST on Tuesday, August 30, or when available space has been filled.
CMS Call: ICD-10 Implementation Strategies for Physicians (Aug. 3)
On August 3, 2011, CMS is hosting a national provider call on "ICD-10 Implementation Strategies for Physicians." The call will focus on ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding, which is scheduled for October 1, 2013. Registration for the call closes on August 2 (or when available space has been filled).
CMS Schedules Meeting on Clinical Lab Code Payments/Genetic Test Codes for 2012 (July 18, 2011)
CMS has announced a July 18, 2011 public meeting to receive comments and recommendations from the public on the appropriate basis for establishing 2012 Medicare payment amounts for a specified list of new CPT codes for clinical laboratory tests. Registration is required. Background information will be posted on the CMS website prior to the meeting. Immediately following this meeting, CMS will host a separate information session to discuss new genetic testing codes (a listing of the new genetic test codes for 2012 is included in the notice. While CMS is not accepting payment recommendations at this time for genetic testing, the agency “is open discussions to the public on recommendations going forward on how these codes should be addressed,” including clinical laboratory versus physician fee schedule assignment, current codes used to reflect test steps, and how various genetic tests are similar to/different from existing laboratory tests.
Comment Opportunity on Revised HCPCS Applications
CMS is seeking comments on proposed revisions to the Healthcare Common Procedure Coding System (HCPCS) code application for the 2013 update. Among other things, CMS is proposing to collect more detailed information on how "durable" items withstand repeated use, along with information on device warranties for items that are the subject of a coding application. CMS also notes that it is considering moving from a paper-based to an electronic HCPCS application process. Comments will be accepted until May 31, 2011.
CMS Forum on 2011 Physician Quality Reporting System and Electronic Prescribing Incentive Programs: ICD-10 Conversion (May 26)
On May 26, 2011, CMS is hosting a Special Open Door Forum on the 2011 Physician Quality Reporting System and Electronic Prescribing Incentive Programs, with a focus on the ICD-10 conversion.
CMS ICD-10 Conversion Activities National Provider Teleconference (May 18)
CMS is hosting a national provider teleconference on "CMS ICD-10 Conversion Activities" on May 18, 2011. In addition to providing a general overview, the call will review the CMS Coverage and Analysis Group’s transition to ICD-10 for lab national coverage determinations, home health conversion, OASIS and procedure code reporting, and an update on claims spanning the implementation date. The target audience for the call includes medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. Registration closes May 17 or when available space is filled.
CMS Meetings on New HCPCS Applications (May-June 2011).
CMS has announced a series of meetings in May and June 2011 to address applications for new or revised Healthcare Common Procedure Coding System (HCPCS) codes for the 2012 update. The schedule is as follows: May 17 & 18 -- Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents (May 18 if needed); May 24 & 25 -- Supplies and Other; June 7 -- Orthotics and Prosthetics; and June 8 -- Durable Medical Equipment (DME) and Accessories. The meeting notice sets forth deadlines for speaker and participant registration.
CMS to Host National Call on "Preparing for ICD-10 Implementation in 2011" (Jan. 12, 2011)
CMS is hosting a national provider teleconference January 12, 2011 on “Preparing for ICD-10 Implementation in 2011.” The call will feature a review of basic information on the transition to ICD-10, discuss implementation planning and preparation strategies, and provide a question and answer period. The registration deadline is 1:00 p.m. ET on January 11, 2011, or when available space has been filled.
Partial Freeze in ICD-9-CM, ICD-10-CM and ICD-10-PCS Codes
CMS has announced that the ICD-9-CM Coordination & Maintenance Committee has finalized its decision to implement a partial freeze for ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10 on October 1, 2013. Under this policy, the last regular annual update to these code sets will be made on October 1, 2011. On October 1, 2012 there will be only limited code updates to both ICD-9-CM and ICD-10 code sets to capture new technology and new diseases. There will be no updates to ICD-9 -CM on October 1, 2013, since that system will no longer be a HIPAA standard. On October 1, 2014 regular updates to ICD-10 will begin.
CMS Guidance to States on ACA Hospice Care, Medicaid Coding Provisions
CMS has issued guidance to states on implementation of Section 2302 of the ACA, which allows children who are enrolled in either Medicaid or CHIP to receive hospice services without foregoing curative treatment related to a terminal illness. Likewise, CMS has provided states with guidance on Section 6507 of the ACA, which mandates that states use certain National Correct Coding Initiative (NCCI) methodologies to promote correct coding and control improper coding leading to inappropriate payment of Medicaid claims.
ICD-10 Implementation in a 5010 Environment Follow-Up Provider Call (Sept. 13, 2010)
CMS will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment" on September 13, 2010. The call is intended for medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. The call will cover: ICD-10; ICD-10 implementation for services provided on and after October 1, 2013; differences between ICD-10 and ICD-9-CM codes; ICD-10-CM basic information for all users; tools for converting codes – General Equivalence Mappings (GEMs); proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases; HIPAA Version 5010; compliance dates and timelines; 5010 before and after ICD-10 implementation; readiness review for implementing HIPAA version 5010 and D.0; how to prepare; and Medicare fee-for-service activities update. The registration deadline is September 10 or when space is filled.
ICD-10 Crosswalk Revisions Meeting (Sept. 15-16, 2010)
The ICD-9-CM Coordination and Maintenance Committee will meet September 15-16, 2010 to receive public input on the crosswalk between the Ninth and Tenth Revisions of the International Classification of Diseases (ICD-9 and ICD-10, respectively).
CMS Call on "ICD-10 Implementation in a 5010 Environment" (June 15)
CMS is hosting a national provider conference call June 15, 2010 on "ICD-10 Implementation in a 5010 Environment.” The target audience for the call is medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. The following topics will be discussed:
- ICD-10: ICD-10 implementation for services provided on and after October 1, 2013; Benefits of ICD-10; Differences between ICD-10 and ICD-9-CM codes; Tools for converting codes – General Equivalence Mappings; Proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases
- HIPAA Version 5010: General Overview HIPAA version 5010 and D.0 and who is impacted; Compliance dates; Benefits; 5010 scope versus ICD-10 Scope; What you need to do to prepare; timelines; Medicare FFS implementation of HIPAA version 5010 and D.0; Impact on paper claim forms.
Registration for the call closes on June 14.
Introduction to ICD-10-CM Provider Call (March 23, 2010)
On March 23, CMS is hosting a National Provider Conference Call on the ICD-10-CM/PCS coding system. Topics to be covered include: the requirement use ICD-10-CM/PCS codes for services provided on or after October 1, 2013; a comparison of the ICD-9-CM and ICD-10-CM; common ICD-10-CM myths and misperceptions; and the impact of ICD-10-CM on medical record documentation.
2010 HCPCS Public Meetings Announced
CMS has announced the dates for the 2010 Healthcare Common Procedure Coding System (HCPCS) public meetings, at which the agency will discuss its preliminary coding and payment determinations for all new public requests for revisions to the HCPCS. On May 4-5, CMS will review applications for codes for Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents; the May 25-26 sessions will review applications for Supplies; on May 27 CMS will focus on Orthotics and Prosthetics codes; and the June 8 session will review Durable Medical Equipment and Accessories coding applications. Draft agendas, including CMS' preliminary decision, will be posted on the HCPCS website at least 4 weeks before each meeting.
CMS Call on ICD-10-CM/PCS MS-DRG Conversion Project (Nov. 19)
On November 19, 2009, CMS is hosting a provider conference call on the ICD-10-CM/PCS Medicare Severity-Diagnosis Related Group Conversion Project. The call will discuss how CMS uses the General Equivalence Mappings (GEM) tool to convert ICD-9-CM data or payment systems to the relevant ICD-10-CM/PCS codes. The registration deadline for the call is November 18.
CMS Releases 2010 HCPCS Update
On November 2, 2009, CMS posted the 2010 update to the Healthcare Common Procedure Coding System (HCPCS) code set.
HCPCS Coding Applications Due January 4, 2010
CMS is accepting applications for the 2011 Healthcare Common Procedure Coding System (HCPCS) update. Completed applications must be received by CMS by January 4, 2010.
CMS Meeting on NPWT Coding
On July 9, 2009, CMS is holding meetings to discuss preliminary determinations on public requests for HCPCS codes for negative pressure wound therapy (NPWT) devices. CMS has tentatively decided not to establish new coding for NPWT systems/components, citing a technology assessment that found that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system.
2011 HCPCS Update Application Form, Deadline Announced
CMS has released the 2011 HCPCS update application form and instructions. To be considered for inclusion in the year 2011 HCPCS update, completed recommendation packets must be received by the close of business on Monday, January 4, 2010.
ICD-10-CM/PCS Implementation (May 19, 2009)
CMS is hosting an ICD-10-CM/PCS Implementation and General Equivalence Mappings National Provider Conference Call on May 19, 2009. This call will include a discussion of the following topics:
- An overview of the ICD-10 final rule, which requires the implementation of ICD-10-CM/PCS on October 1, 2013;
- The differences between ICD-9-CM and ICD-10-CM/PCS codes;
- The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and
- Resources to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS.
Conference call discussion materials and registration information will be available on the CMS website.
No Delay in HIPAA Code Set/Standard Rules
The Obama Administration has been reviewing regulations issued late in the Bush Administration, including HHS final rules published January 16, 2009 that mandate the use of updated diagnosis and procedure codes (the ICD-10-CM rule) and updated standards for electronic health care and pharmacy transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Administration has decided not to delay implementation of these final rules or reopen the rules for comment.
ICD-9-CM Coordination and Maintenance Committee Meeting (March 11-12, 2009)
On March 11-12, 2009 the ICD-9-CM Coordination and Maintenance Committee is holding a public forum to discuss proposed changes to ICD-9-CM. The first day of the meeting will be devoted to procedure code issues, while the second day will concentrate on diagnosis code issues. The registration deadline is March 5, 2009.
2009 HCPCS Meeting Dates Announced
On February 27, 2009, CMS published a notice announcing the dates for the 2009 Healthcare Common Procedure Coding System (HCPCS) public meetings to discuss CMS’s preliminary coding and payment determinations for public requests for revisions to the HCPCS, including dates to consider new drug code requests. The meeting dates are as follows:
April 28, 2009: Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents (CMS notes that the April 29 date is tentative and may not be needed)
May 12 - 13, 2009: Supplies and Other Items
May 27, 2009: Orthotics and Prosthetics
May 28, 2009: Durable Medical Equipment (DME) and Accessories
July 9, 2009: DME and Accessories, including Negative Pressure Wound Therapy (NPWT) devices.
The notice outlines deadlines for primary speakers and other attendees. Draft agendas, including a summary of each request and CMS’s preliminary decision, will be posted on the CMS website at least 4 weeks before each meeting.
Implementation of ICD-10 Coding
The Department of Health and Human Services (HHS) published a final rule on January 16, 2009 adopting new code sets to be used by the public and private sectors for reporting diagnoses and inpatient procedures in health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the rule adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD–10–CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD–10–PCS) for inpatient hospital procedure coding. These codes replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification Volume 3 for diagnosis and procedure codes, respectively. HHS notes that the shortcomings of the current ICD-9 system include limited ability to accommodate new procedures and diagnoses; lack of specificity and detail; inconsistent terminology, and lack of codes for preventive services. On the other hand, HHS expects adoption of the ICD-10 code set to support value-based purchasing and reporting of quality data and ensure more accurate payments for new procedures. While HHS believes the new systems will result in significant long-term savings, short-term implementation costs (training, productivity losses, and systems changes) could reach almost $2 billion. The rule is effective October 1, 2013, two years later than provided in the August 22, 2008 proposed rule.
HCPCS Applications Due Jan. 5, 2009
Applications for new or revised Healthcare Common Procedure Coding System (HCPCS) codes for the 2010 update are due January 5, 2009.
2009 HCPCS Code Update
CMS has released the 2009 update of the Healthcare Common Procedure Coding System (HCPCS) code set.
Medicare Medically Unlikely Edits Announced
CMS has released most of its “Medically Unlikely Edits” (MUE), which are used by Medicare contractors when processing claims to ensure that providers and suppliers do not report excessive services. An MUE for a HCPCS/CPT code is the maximum units of service under most circumstances that a provider would report for a code for a single beneficiary on a single date of service; claims with more than the MUE edit amount will be denied (unless a modifier is used to used to report medically necessary units of service in excess of an MUE value). The MUE currently contains edits for about 9,700 HCPCS/CPT codes, although CMS is not publishing all active MUEs since it could diminish the effectiveness of MUE edits that are designed to detect and deter questionable payments rather than billing errors. CMS will update the list quarterly.
ICD-10-CM/PCS Conference Calls
CMS will host a series of national provider calls regarding issues associated with the adoption of the ICD-10 coding system. Separate calls are scheduled for hospital staff (October 14), other Part A and Part B providers (November 12), and physicians (November 17). Call details, including registration information and CMS’s slide presentation, are available on the CMS web site.
The transcript of the call for hospital staff on October 14, 2008 is now available.
