The healthcare industry’s shift from ICD-9-CM to ICD-10-CM coding is a significant update impacting how medical diagnoses are classified and reported. This transition, mandated by the 2010 Affordable Care Act, affects all entities involved in HIPAA-regulated transactions, notably including Medicare billing for clinical laboratory services and the crucial area of Cpe Diagnosis Codes. The deadline for this change was set for October 1, 2016, superseding the older ICD-9-CM system for diagnoses. For comprehensive details on the implementation of ICD-10-CM coding, refer to the dedicated resources available at /ICD10.
It’s important to note that the Centers for Medicare & Medicaid Services (CMS) initiated a Partial Code Freeze for both ICD-9-CM and ICD-10 updates from October 1, 2011, through September 30, 2016. Further information regarding this Partial Code Freeze can be found at /Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf (PDF).
To ensure a smooth and clinically consistent conversion between the two coding systems, CMS employed General Equivalence Mappings (GEMs) to translate ICD-9-CM codes to their ICD-10-CM equivalents, particularly vital for maintaining accuracy in cpe diagnosis code reporting. CMS provided these GEMs for 2018, marking the final year they would be utilized, as ICD-10-CM has been in effect for several years since its implementation. The last set of GEMs (2018) is accessible at /ICD10.
Due to the extensive volume of codes involved in the October 2018 ICD-10 update, Medicare’s shared systems incorporated these new codes in the subsequent January 2019 quarterly update. This October 2018 update encompassed all deleted and replacement ICD-10-CM codes. The January 2019 update specifically included new ICD-10-CM codes. While the system implementation occurred in January, the effective date for these new codes remained October 1, 2018. Codes that were deleted became invalid for payment after September 30, 2018. Contractors were instructed to adjust claims as needed. This detailed update process is especially relevant for professionals working with cpe diagnosis codes to ensure accurate and timely billing and coding practices.
