Starting with the 2005 codes, ICD-9 codes now will be updated two time each year: once in October and once in April.

Previously, ICD-9 codes have been updated once a year, October 1.

Now the new year's code set will officially take effect on October 1 of the previous year (October 1, 2004 for the 2005 codes), and will be updated in April.

The Medicare Prescription Drug Improvement and Modernization Act of 2004 contains a provision that ICD-9 codes must be updated twice a year. Both ICD-9 diagnosis and ICD-9 procedure codes are included in the mandate.

The goal of the additional update is to improve data collection and allow for new codes to be implemented to reflect new technology.

It is not exactly clear yet how the new required update will be accomplished. At the last two ICD-9 CM Coordination and Maintenance committee meetings, concerns were raised on the potential difficulty of updating books, software, and other products containing ICD-9 codes on a twice-a-year basis.

The Centers for Medicare and Medicaid and the National Center for Health Statistics are working to develop a plan for how the process will work and will offer a proposal of how the new update process will work as part of a Notice of Proposed Rulemaking (NPRM) due out the first half of this year.

Our thanks to Unicor Medical and Coding News for this information. They, and we, will follow this important issue and keep you up to date on developments as information is released from CMS and NCHS.

The update season has officially begun now that the fiscal year 2005 code revisions have been released. The revisions, which become effective for Medicare claims on October 1, 2004—and with no grace period as in past years—will affect every specialty, some harder than others.

It is important for practices to begin assessing how these revisions will affect current operations now so that these changes can be implemented October 1, particularly since there is no grace period for Medicare claims this year.

This year, changes total the following:

171 new diagnosis codes
203 revised diagnosis codes
25 invalid diagnosis codes
18 revised procedure codes
54 new procedure codes

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"CMS is instructing carriers, DMERCs, and fiscal intermediaries to eliminate the 90-day grace period for billing discontinued HCPCS (CPT® and HCPCS Level II) codes."

CMS has done away with the 90 day grace period. You will no longer have 90 days to adopt the new code sets but must begin using them on the day when they go into effect.

This means that you need to have your 2005 ICD-9-CM code books before October 1, 2004. And you will need to have your 2005 CPT-4 books before December 31, 2004. Reserve your copies now to ensure that you get them as soon as possible and avoid having your claims returned as unprocessable.

Here is the CMS MedLearn article regarding the CPT and HCPCS code sets.

CPT Code Set

And here is the CMS MedLearn article regarding the ICD-9-CM codes and the elimination of the 90 day grace period.

ICD-9-CM Code Set


Outdated codes will not be accepted. Be sure to have the new code books BEFORE the deadline.