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 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.

A final review and comment period will be held from July 1, 2013 through December 15, 2013. The complete set of HEDIS ICD-10 code recommendations will be posted. This will be the final opportunity for organizations to review and comment. Note: This process and timeline is separate from the HEDIS Public Comment process and timeline.

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.

Click here for the list of measures that will be posted for the final HEDIS ICD-10 review and comment period.