HEDIS and ICD-10 Information

ICD-9-CM is an official classification system that practitioners use to code diagnoses and procedures on health care claim forms in the United States. Organizations use ICD-9-CM codes from claim and encounter data to identify diagnoses and procedures for HEDIS reporting.

To comply with CMS requirements, health care providers will be required to switch to ICD-10 Diagnosis and Procedure codes effective October 1, 2014. To accommodate the change, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure in time for inclusion in the HEDIS 2015 publications.

Beginning in 2011, NCQA began converting approximately one-third of affected measures each year. With support from the HEDIS Expert Coding Panel, NCQA staff identified ICD-10 codes for each HEDIS coding table that contained ICD-9-CM codes. NCQA posted the proposed ICD-10 codes to the NCQA Web site for organizations to review and provide comments (July 1 – December 16, 2013).

HEDIS 2015 publications will include ICD-9 and ICD-10 codes. NCQA will begin the phase-out of ICD-9 codes in HEDIS 2016. Codes will be removed from a measure when the look-back period for the measure, plus one additional year, has been exhausted. This is consistent with NCQA’s current policy for removing obsolete codes from measure specifications.