Access the Final Report:ICD-10-CM/PCS Coding Maintenance Operational Guidance
The Opportunity
In January 2009, the Department of Health and Human Services (DHHS) published its final rule on the conversion of the national medical coding system from the use of ICD-9 to ICD-10. This conversion requirement is anticipated to take effect October 1, 2013. In addition to ICD-CM codes, Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) codes are also among the standard medical codes sets selected by DHHS for use in the exchange of electronic clinical health information and interoperability standards, and are being referenced more readily in quality measurement. With this shift in national coding standards and the evolution of electronic health record (EHR) standards, it will be necessary to ensure measurement standards and their specifications reflect these changes.
Furthermore, as regulations and trends evolve, the focus in quality measurement is shifting to electronic data collection, code set transitions, and measure retooling; understanding the implications of these changes and preparation for this transition is necessary. While also acknowledging the work of other organizations and groups around bridging terminologies and measurement standards (i.e. the Healthcare Information Technology Standards Panel (HITSP), the Health IT Standards Panel, and NQF’s work with the Quality Data Model (formerly QDS) developing a plan and guidelines for operationalizing and integrating the work of these groups into NQF maintenance and submission processes, is an important step before implementing new coding requirements for measure stewards and developers.
For additional information, read the full Code Maintenance project summary (PDF).
About the Project
This project began in July 2009.
NQF oversaw the in-depth examination of the impact that changes to coding criteria and measure specification will have on measure development and submission for NQF endorsement. The project was guided by an expert advisory panel.
The work of this project began with an in-depth examination of the impact of changes to coding criteria and measure specification on measure development and submission for NQF-endorsement under the guidance of an expert advisory panel. Ultimately, the work of this project yielded recommendations for methodologies and tools for converting code sets; recommendations for NQF measure submission and maintenance processes involving multiple code sets; engagement of measure developers in developing best practices for coding transitions and specifying measures with new code sets; and provided measure developers with guidelines under which to submit measure specifications using equivalent ICD-10 codes.
Objectives
To ensure that all NQF-endorsed measures have updated coding specifications prior to the slated October 2013 national coding conversion deadline, this effort provided guidance and recommendations to NQF for reviewing measures with coding updates and integrating coding maintenance into the endorsement/maintenance review cycle.
Process
This project did not follow NQF's formal Consensus Development Process; no products will be endorsed. An expert advisory panel was formed with expertise in medical coding, measure development, and performance measurement using electronic clinical information. This panel provided NQF with relevant industry and public input; the resulting policies and products were developed in alignment with NQF's role as a national voluntary consensus standards-setting organization.
Funding
This project was funded under NQF's contract with the Department of Health and Human Services, Consensus-based Entities Regarding Healthcare Performance Measurement.
Contact Information
For more information contact Ashlie Wilbon, RN, MPH, at 202-783-1300 or via e-mail at performancemeasures@qualityforum.org.
Notes
1 United States Dept of Health and Human Services, Frequently Asked Questions about Code Set Standards Adopted Under HIPAA; 2000. Available at http://aspe.hhs.gov/admnsimp/faqcode.htm. Last Accessed June 2009.
NQF seeks to ensure that measurement standards and their specifications are updated to reflect the conversion of the national medical coding system from ICD-9 to ICD-10 and the use of clinical code sets for the electronic quality and performance measurement data.
NQF issued a Notice of Intent (Word) to announce its plan for assessing and modifying its measure submission and maintenance processes to support changing code set requirements for DHHS national medical coding standards and electronic performance measurement data collection.
The Call for Nominations closed on August 19, 2009.
For additional information on the formation process of the expert panel, please refer to the Call for Nominations document (Word).
The Expert Panel will have a series of meetings and conference calls to determine the implications of coding transitions on quality measures and develop recommendations for measure developers and NQF to implement and review converted measures.
Code Maintenance Expert Panel held their first conference call.
Code Maintenance Expert Panel meeting was open to NQF Members and public. It was held at the Marriott at Metro Center in Washington, DC.
The CSAC reviewed the Coding Maintenance draft framework and operational guidance and approved the recommendations provided by the Expert Panel.
