HEDIS and ICD-10 Information

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

To accommodate the switch to ICD-10 (implementation date to be determined), NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure. Beginning in 2011, NCQA began converting 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 its Web site for organization review and comment (July 1–December 16, 2013).

After the implementation date is set, NCQA will add ICD-10 codes to the HEDIS measure specifications to correspond with the impacted measurement year. ICD-9 codes will be phased out using NCQA’s policy for removing obsolete codes: codes are removed from a measure when the look-back period for the measure, plus one additional year, is exhausted. NCQA posts FAQs about ICD-10 and HEDIS on the FAQ page of the NCQA Web site at: http://faq.ncqa.org.