World Health Assembly adopts ICD-11: When will member states start using the new edition?

Post #354 Shortlink: https://wp.me/pKrrB-4Sm

On May 25, 2019, the 72nd World Health Assembly voted unanimously to adopt the ICD-11, the next edition of the International Classification of Diseases (ICD).

Endorsement won’t come into effect until January 1, 2022, which is the earliest date that member states can begin using ICD-11 for reporting data.

A stable version of the ICD-11 MMS was released in June 2018 to enable member states to begin planning for implementation. This release was replaced in April 2019 with ICD-11 MMS Version: 04/2019.

ICD-11 is an electronic classification containing over 55,000 codes and a considerably more complex product than ICD-10. It has been designed to incorporate or link with other ICD classifications, such as the International Classification of Functioning, Disability and Health (ICF), the WONCA* developed International Classification of Primary Care (ICPC), and with the SNOMED-CT and OrphaNet terminologies.

Even the earliest implementers will need several years to evaluate the new edition, determine how they will use ICD-11, complete translations, produce training and implementation materials and prepare their health systems for migration. Japan is understood to be well advanced with translations and planning.

There is no mandatory implementation date: member states will migrate to ICD-11 at their own pace and according to their countries’ needs and resources but there is an expectation that countries will start planning for transition. Some member states may need to develop clinical modifications of ICD-11 for country specific use. A few countries still use ICD-9.

Global implementation of the new edition will be a patchy and prolonged process and during the transition period, WHO will be accepting data reported using both ICD-10 and the new ICD-11 code sets until the majority of member states have transitioned to the new edition. WHO has said that the last update to ICD-10 will be Version 2019.

No member states have announced timeline projections but below is a round-up of ICD-11 transition planning activities already in progress:

*World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.

 

NHS England

NHS England mandates the use of ICD-10 in secondary care (currently using ICD-10 Version 2015).

As a WHO Collaborating Centre and designated UK Field Trial Centre, NHS Digital has taken part in ICD-11 Field Trials.

NHS Digital has said:

No decision has been made for the implementation of ICD-11 in England, however NHS Digital plan to undertake further testing of the latest release and supporting products that will inform a future decision.

NHS Digital Delen: ICD-11 resources page

Proposed Future Additions

Over the coming months, NHS Digital would like to engage and invite all users of ICD to participate and interact with the review process.

To support this, we are proposing to add the following information to our Delen site;

  • A mechanism for questions, issues, concerns and errors relating to ICD-11 to be raised to us as the UK Field Trial Centre.
  • A high-level overview of our future plans
  • Presentations providing more information on ICD-11
  • e-Learning materials to support familiarisation with ICD-11. Topics to include post coordination / cluster coding, chapter and code structure, chapter specific changes and notes, conventions etc
  • Further testing – parallel coding in ICD-10 in real-time. If you would be interested in taking part in this please let us know by emailing icd-11@nhs.net

Until NHS England has implemented ICD-11, the mandatory classification system for use in the NHS remains ICD-10.

Since April 2018, SNOMED CT (which replaces the Read Codes/CTV3 clinical terminology) has been the mandatory terminology system for use in NHS primary care at the point of contact and forms an integral part of the electronic patient record (EPR).

SNOMED CT terminology system is already used in some secondary care settings but is planned to be implemented across all secondary care, acute care, mental health, community systems, dentistry and other systems used in direct patient care by April 2020.

SNOMED CT terminology system and clinical classifications, like ICD-10, work together to fulfil different needs:

Source: Presentation: NHS Digital: Clinical Coding for non coders – Overview of clinical coding, how ICD-10 and SNOMED CT work together, and the role of the Clinical Classifications Service.

For more information on the planning that will be required before ICD-11 can be implemented within the NHS, see BETA – Clinical Information Standards, section: ICD-11 and the new Procedure Based Classification (PBC).

Resources:

NHS Digital Delen Home Page

NHS Digital SNOMED CT resources

SNOMED CT UK Edition browser

 

Australia

Australia uses a modification of the WHO’s ICD-10, known as ICD-10-AM [1].

Australian classification standards and statistics agencies were well represented on the ICD-11 Joint Task Force, with 5 of the Joint Task Force’s 21 members representing Australia, plus co-chair (Dr James Harrison, Director, Research Centre for Injury Studies, Flinders University, Adelaide) and observer (Dr Richard Madden, Professor of Health Statistics and Director National Centre for Classification in Health, University of Sydney).

For comparison, the UK had only an observer on the Joint Task Force; the U.S. had 4 participants and an observer.

The Australian Institute of Health and Welfare (AIHW) has been conducting a review of ICD-11 to inform and assist decision-makers about the new edition and its potential for adoption in Australia, see Post: #349: Australia: Potential adoption of ICD-11: Pre-consultation for decision makers.

1 Australian Consortium for Classification Development

 

Canada

Canada uses a modification of the WHO’s ICD-10, known as ICD-10-CA, developed by Canadian Institute for Health Information (CIHI) [1].

CIHI is participating in the testing of ICD-11 and assessing the implications for potential implementation in Canada.

CIHI has said that no decision has been made for the implementation of ICD-11 in Canada and that they are currently working on a number of initiatives to better understand the differences between ICD-10-CA and ICD-11 to help inform the business and statistical implications of adoption.

April 15, 2019 webinar:

https://www.cihi.ca/en/submit-data-and-view-standards/codes-and-classifications/icd-11

https://www.cihi.ca/fr/normes-et-soumission-de-donnees/codification-et-classification/cim-11

Introduction to ICD-11 — Part 1 Transcript and Recording

https://www.cihi.ca/en/bulletin/webinar-introduction-to-icd-11-part-1

https://www.cihi.ca/fr/bulletin/webinaire-introduction-a-la-cim-11-partie-1

Introduction to ICD-11 — Part 2 Transcript and Recording

https://www.cihi.ca/en/bulletin/webinar-introduction-to-icd-11-part-2

https://www.cihi.ca/fr/bulletin/webinaire-introduction-a-la-cim-11-partie-2

 

1 Version 2018 ICD-10-CA/CCI, Canadian Coding Standards and related products

 

United States

The National Center for Health Statistics (NCHS) is the federal agency responsible for the use of ICD-10 in the United States.

ICD-10 has been used in the U.S. to code and classify mortality data from death certificates since January 1999. NCHS developed a clinical modification of ICD-10 for morbidity purposes (ICD-10-CM) which replaced ICD-9-CM on October 1, 2015.

Since its initial launch, in 2007, the U.S. has maintained high level participation in the ICD-11 development process and its ongoing update and improvement:

The U.S. provided representatives from professional and scientific organisations, academics and practitioners for the ICD-11 Topic Advisory Groups (TAGs) and sub working groups. Stanford Center for Biomedical Informatics Research developed the web based iCAT Collaborative Authoring Platform on which ICD-11 was developed.

The U.S. has representatives on the ICD-11 governance committees via the WHO-FIC Network; the Medical Scientific Advisory Committee (MSAC); the Classifications and Statistics Advisory Committee (CSAC); the Mortality and Morbidity (MbRF) Reference Groups; and the Functioning and Disability Reference Group, which have oversight for the annual updating and ongoing improvement of the global ICD-11 edition.

Dr Geoffrey Reed (WHO, Geneva; Columbia University) is Senior Project Lead for the ICD-11 Mental Health chapter and a member of the MSAC; Steven Hyman, MD (former Director of the National Institute of Mental Health (NIMH) and former DSM-5 Task Force member) chaired the Topic Advisory Group for Mental Health; Michael B First, MD has served as a key external advisor to the Mental Health chapter. Harold Pincus, MD co-chaired the ICD-11 Quality and Patient Safety Topic Advisory Group.

Dr Christopher Chute (John Hopkins University) chaired the ICD-11 Revision Steering Committee, was a member of the Joint Task Force and now co-chairs the MSAC; Donna Pickett (Chief, Classifications and Public Health Data Standards, NCHS, Centers for Disease Control and Prevention, Head, Collaborating Center for the WHO-FIC in North America) co-chaired the Morbidity TAG, was a member of the Joint Task Force and is a member of the CSAC; Dr Robert Anderson (Chief, Mortality Statistics Branch Division of Vital Statistics, Centers for Disease Control and Prevention) was a member of the Joint Task Force and co-chaired the Mortality TAG; Cille Kennedy (ASPE) co-chaired the ICD-11 Functioning TAG; Sue Bowman (Senior Director of Coding Policy and Compliance, AHIMA) is a representative on the ICD-11 Morbidity Reference Group (MbRF).

Around 25 member states have modified ICD-10 for country specific use.

WHO is still formulating policies around the licensing of ICD-11 but it is understood that the intention is to limit development of national modifications.

See Presentation slides #36-38 for more information on licensing and the development of country modifications: Insights into the Next Revision: Like Texas, Everything is Bigger in ICD-11, Kathy Giannangelo, RHIA, CCS, CPHIMS, FHIMA, Texas Health Information Management Association.

It would be premature to speculate when the U.S. might be ready to migrate to ICD-11 for mortality (cause of death reporting) and whether ICD-11 will be adequate as a morbidity classification system for U.S. use or whether NCHS will need to develop a clinical modification, as it did for ICD-10.

It was put forward at the June 5-6, 2019 NCVHS meeting that the U.S. might potentially use ICD-11 unmodified if WHO were to incorporate some additional terms within the global ICD-11 edition.

NCVHS has initiated the process of planning for transition to ICD-11 at the federal level.

In February 2019, William W Stead, MD, Chair, NCVHS, sent a letter to the Secretary of Health and Human Services (HHS) recommending a simplified process for adopting future versions of ICD. The letter also recommended that HHS should invest now in an ICD-11 evaluation project and develop a plan to enable a smooth, transparent transition from ICD-10 to ICD-11 at the optimal time.

 

NCVHS meetings:

The U.S. National Committee on Vital and Health Statistics (NCVHS) serves as the statutory public advisory body to the Secretary of Health and Human Services for health data, statistics, privacy, and national health information policy and the Health Insurance Portability and Accountability Act (HIPAA).

A National Committee on Vital and Health Statistics Full Committee Meeting was held on June 5-6, 2019.

Agenda: Full Committee Meeting-June 5-6, 2019

Presentations were given for Agenda item: ICD-11 Project:

Recording Mp3: Full Committee Meeting – Day 1 June 5, 2019

Agenda item: ICD-11 Project: presentations and discussions starts 2hrs: 50 mins in from start; closes 5hrs 55mins from start.

Recording Mp3: Full Committee Meeting – Day 2 June 6, 2019

Meeting summaries, transcripts, presentation slides may be available later.

 

ICD-11 Expert Roundtable Meeting August 6-7, 2019

National Committee on Vital and Health Statistics Subcommittee on Standards held an

ICD-11 Evaluation Expert Roundtable Meeting on August 6-7, 2019.

Mp3 recordings of this two day NICD-11 Expert Roundtable meeting are now available:

Agenda

Recording Mp3 ICD-11 Expert Roundtable Meeting – Day 1 August 6, 2019

Recording Mp3 ICD-11 Expert Roundtable Meeting – Day 2 August 7, 2019

Update

Transcript Day 1 –  August 6, 2019
[165pp]

Transcript Day 2 – August 7, 2019
[129pp]

These transcripts of the ICD-11 Roundtable two day meeting are 165 and 129 pages long and the files have only recently been posted on the NCVHS site.

I have not had time to review these yet, but they are essential reading for industry and public stakeholders in the U.S.’s potential adoption of ICD-11 or NCHS/CDC’s potential development of a clinical modification of ICD-11.

Federal Register notice of meeting:

PDF: https://www.govinfo.gov/content/pkg/FR-2019-07-08/pdf/2019-14375.pdf

Presentation slides may be available later.

Slide presentation: NCVHS Update, Rich Landen, Member, National Committee on Vital and Health Statistics, Co‐chair, Standards Subcommittee, August 2019: 

Update: 

A preliminary summary of the August 6-7, 2019 ICD-11 Roundtable meeting has now been posted by NCVHS:

International Classification of Diseases,
Eleventh Revision (ICD-11) Expert Roundtable

Publication Date: October 10, 2019 PDF: Preliminary Meeting Summary

Key Points for planned Letter to Secretary, HHS:

Appendix E: Final Research Questions [Will be inserted by Expert Roundtable group when final]

Appendix F: ICD-11 Communications Plan [Will be inserted by Expert Roundtable group when final]

 

Coding industry reports:

AHIMA Participates in ICD-11 Expert Roundtable summary by Sue Bowman, MJ, RHIA, CCS, FAHIMA, Aug 28, 2019

US gets the ball rolling on ICD-11 AAPC, August 16, 2019

 

1 WHO Group Discusses ICD-11 Transition Planning report by Sue Bowman, MJ, RHIA, CCS, FAHIMA for Journal of AHIMA (American Health Information Management Association)

2 Presentation: Status on ICD-11: The WHO Launch National Committee on Vital and Health Statistics, July 18, 2018, Donna Pickett, Chief, Classifications and Public Health Data Standards, Head, Collaborating Center for the WHO-FIC in North America; Robert N. Anderson, PhD Chief, Mortality Statistics Branch Division of Vital Statistics

 

WHO-FIC Africa

WHO-FIC Africa Collaborating Centre has said:

ICD-10 is the current standard for Morbidity (cause of illness) and Mortality (cause of death (COD) coding.

The ongoing implementation and maintenance of ICD-10 for mortality and morbidity coding remain a core focus of the WHO-FIC Collaborating Centre (African region). Following the release of ICD-11 MMS in June 2018, there will be increasing focus on ICD-11 in the work plan of the collaborating centre. Inputs to the development of ICD-11 are essential to ensure that the classification meets regional needs.

WHO-FIC Africa News: WHO on the Implementation of ICD-11, November 2018:

WHO-FIC collaborators met in Pretoria (South Africa) on 7 November 2018, discussing the implications for implementing ICD-11 and ICHI. We linked up with Nenad Kostanjsek from WHO (Geneva), who shared his thoughts about the preparation for implementation of ICD-11.

Download presentation slides

 

Other member states

This table from the eHealth DSI Semantic Knowledge Base project compiles information provided from a number of member states on their use of ICD (or a modification of ICD) and their plans regarding potential future implementation of ICD-11. Information provided by: Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, France, Germany, Greece, Hungary, Ireland, Italy, Luxenbourg, Malta, Netherlands, Portugal, Slovenia and Spain.

Table: Current status of the use of ICD by eHDSI deploying countries (2018)

Resources:

ICD-11: The 11th Revision of the International Classification of Diseases – Site maintained by eHealth DSI Semantic Community providing resources for ICD-10, ICD-11, ICD derivative classifications and other classification and terminology systems

Insights into the Next Revision: Like Texas, Everything is Bigger in ICD-11, Kathy Giannangelo, RHIA, CCS, CPHIMS, FHIMA, Texas Health Information Management Association

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ICD-11 implementation package

Post #353 Shortlink: https://wp.me/pKrrB-4R7

On Saturday, May 25, 2019, member states meeting at the 72nd World Health Assembly voted unanimously to approve the draft resolution to adopt the Eleventh revision of the International Classification of Diseases. The resolution passed with no amendments.

Adoption comes into effect on January 1, 2022, subject to transitional arrangements. After this date, member states can start using or transitioning to the ICD-11 codes when they have prepared their health systems for migration from earlier editions.

Source: Presentation slides: Dr Robert Jakob, November 2018 Information session on ICD-11

 

The two key documents for Agenda Item 12.7 Eleventh revision of the International Classification of Diseases are:

A72/29 Add.1
Eleventh revision of the International Classification of Diseases
Draft Resolution

A72/29
Eleventh revision of the International Classification of Diseases
Report by the Director-General

 

Implementation package

The World Health Organization (WHO) has prepared an implementation package. These tools can be accessed at ICD-11.

 

1) ICD-11 Implementation or Transition Guide (version 1.05, May 2019)

This document is a part of the ICD11 implementation package¹ developed by the World Health Organization. This document also provides some background related to the development of the ICD11 and its components. The document outlines essential issues that countries need to consider in the lead up to and during the transition from an existing ICD environment to the eventual implementation of ICD11.

1 The ICD-11 implementation package comprises the Classification System, the Coding Tool, Browser and all supporting documents including the Reference Guide and Implementation Guide, and a set of tools. Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.

 

2) Coding tool (multilingual)

Index based search tool.

See Additional resources [1] for NHS overview of ICD-11 Coding Tool.

 

3) ICD-11 browser for Mortality and Morbidity Statistics (MMS)

Blue ICD-11 MMS platform (current release: 04 / 2019)

English: https://icd.who.int/browse11/l-m/en

Spanish: CIE-11 para estadísticas de mortalidad y morbilidad (Versión : 04 / 2019): https://icd.who.int/browse11/l-m/es

See Additional resources [2] for NHS overview of ICD-11 MMS Browser and [3] for general overview of ICD-11.

 

4) ICD-11 Reference Guide (version 11-04-2019)

Detailed guide to ICD-11 and how to use it; update and maintenance workflow; updating cycles; requirements for proposal submission.

 

5) ICD-10 / ICD-11 mapping Tables

Map ICD-11 codes to and from ICD-10 (links to Zip file; crosswalks in Text and MS Excel formats)

 

6) Orange ICD-11 Maintenance Platform

English: https://icd.who.int/dev11/l-m/en

The audience for this site is the maintainers, contributors and translators of the classification. The content of the Orange browser is not the released version of the classification. The content is updated on a daily basis to incorporate changes approved since the most recent release of the Blue ICD-11 browser for Mortality and Morbidity Statistics (MMS).

The Orange Maintenance Platform incorporates the ICD-11 Proposal Mechanism (a proposal and commenting tool for which registration is required). Once an account is registered, new proposals, comments and suggestions for changes and enhancements to existing content can be submitted and notifications set up. For help with submissions see: Maintenance Platform User Guide.

 

Specialty versions and derived classifications

Specialty versions provide more detail for particular user groups, such as Mental Health, Neurology, Dermatology and less detail for primary care or low diagnostic resource settings.

For ICD-11, the WHO Department of Mental Health and Substance Abuse has developed a companion publication to ICD-11 Chapter 06 for mental health professionals, general clinical, educational and service use.

The Clinical Descriptions and Diagnostic Guidelines for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders (CDDG) provides expanded disorder descriptions and includes: essential (required) features, severities, boundaries with other disorders and normality, differential diagnoses, additional features and culture-related features.

WHO has given no firm release date but says the CDDG will be published “as soon as possible” following approval of the overall system by the WHA¹.

Also under development is the ICD-11 PHC – a clinical guideline written in simpler language to assist non-mental health specialists, especially primary care practitioners and non medically trained health workers, and for use in low resource settings and low- to middle-income countries with the diagnosis and management of 27 mental disorders. No finalization and publication date is available. Like the ICD-10 PHC (1996), this revised edition will not be a mandatory classification for member states.

1 Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19.

 

Linkages with other classifications and terminologies

ICD11 incorporates or links with the following classifications and terminologies through the ICD11 Foundation:

• International Classification of Disease for Oncology – ICD-O
• International Classification of External Causes of Injury – ICECI
• International Classification of Functioning, Disability and Health – ICF
• International Classification of Primary Care – ICPC [Ed: developed/maintained by WONCA]
• Other terminologies such as OrphaNet and SNOMED-CT

Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.

 

Additional resources:

1 NHS Digital: ICD-11 Coding Tool Overview, September 2018

2 NHS Digital: ICD-11 Browser Overview, September 2018

3 NHS Digital: ICD-11 Overview

4 Presentation: Information session on ICD-11 Dr Robert Jakob, Team Leader, WHO, Geneva, Classifications, Terminologies and Standards, November 2018

Presentation: NHS Digital: Clinical Coding for non coders – Brief overview of clinical coding and the role of the Clinical Classifications Service

6 ICD-11: The 11th Revision of the International Classification of Diseases – Site maintained by eHealth DSI Semantic Community providing resources for ICD-10, ICD-11, ICD derivative classifications and other classification and terminology systems

HHS issue Final Rule: ICD-10-CM compliance deadline set for October 1, 2015

Post #314 Shortlink: http://wp.me/pKrrB-3ZI

CMS Press Release:  Final Rule July 31, 2014

Coding industry and professional body reaction

ICD-10 Testing: Final rule overshadows CMS testing plans

ICD10 Watch | Carl Natale | August 2, 2014

+++
Debunking Myths and Misperceptions of ICD-10 – Journal of AHIMA illustrates why it’s time for 10

AHIMA | News Release | July 30, 2014

+++
DHHS final rule on ICD-10 delay ready for publication

ICD10Watch | Carl Natale | July 31, 2014

+++
CMS Confirms ICD-10 Deadline

Health Leaders Media | Michelle Leppert | August 1, 2014

+++
ICD-10 Final Rule Released, October 2015 Official Compliance Deadline

Journal of AHIMA | Mary Butler | July 31, 2014

+++
ICD-10 Final Rule Stirs Angst, Apprehension

ICD10 Monitor | Chuck Buck | August 1, 2014

+++
(From June 12, 2014)

SNOMED, ICD-11 Not Feasible Alternatives to ICD-10-CM/PCS Implementation

AHIMA | Sue Bowman | June 12, 2014

“For the US, [2017] is the beginning, not the end, of the process toward adoption of ICD-11.”

+++
Resources

Federal Register: HHS ICD-10-CM Compliance FINAL RULE

[PDF] DEPARTMENT OF HEALTH AND HUMAN SERVICES, Office of the Secretary
45 CFR Part 162 [CMS-0043-F] RIN 0938-AS31
Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD–10–CM and ICD-10-PCS) Medical Data Code Sets

CMS Press Release:  Final Rule July 31, 2014

CMS NEWS

FOR IMMEDIATE RELEASE    Contact: CMS Media Relations

July 31, 2014                                   (202) 690-6145 or press@cms.hhs.gov

 

Deadline for ICD-10 allows health care industry ample time to prepare for change

Deadline set for October 1, 2015

The U.S. Department of Health and Human Services (HHS) issued a rule today finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The ICD-10 codes on a claim are used to classify diagnoses and procedures on claims submitted to Medicare and private insurance payers. By enabling more detailed patient history coding, ICD-10 can help to better coordinate a patient’s care across providers and over time. ICD-10 improves quality measurement and reporting, facilitates the detection and prevention of fraud, waste, and abuse, and leads to greater accuracy of reimbursement for medical services. The code set’s granularity will improve data capture and analytics of public health surveillance and reporting, national quality reporting, research and data analysis, and provide detailed data to enhance health care delivery. Health care providers and specialty groups in the United States provided extensive input into the development of ICD-10, which includes more detailed codes for the conditions they treat and reflects advances in medicine and medical technology.

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS). “For patients under the care of multiple providers, ICD-10 can help promote care coordination.”

Using ICD-10, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM. Moreover, the level of detail that is provided for by ICD-10 means researchers and public health officials can better track diseases and health outcomes. ICD-10 reflects improved diagnosis of chronic illness and identifies underlying causes, complications of disease, and conditions that contribute to the complexity of a disease. Additionally, ICD-10 captures the severity and stage of diseases such as chronic kidney disease, diabetes, and asthma.

The previous revision, ICD-9-CM, contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.

ICD-10 represents a significant change that impacts the entire health care community. As such, much of the industry has already invested resources toward the implementation of ICD-10. CMS has implemented a comprehensive testing approach, including end-to-end testing in 2015, to help ensure providers are ready. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready.

For additional information about ICD-10, please visit: http://www.cms.gov/ICD10

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