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. In March of 2011 and 2012, NCQA posted proposed ICD-10 codes to the NCQA Web site for organizations to review and provide comments.
The complete set of HEDIS ICD-10 code recommendations has been posted and the final review and comment period is being held from now through 9:00am (EST), December 16, 2013. This is the final opportunity for organizations to review the recommendations and provide feedback to NCQA before the HEDIS ICD-10 codes are published. Please click here for more information and to review the recommendations.