Coded data is used for multiple purposes in the healthcare industry. Up-to-date terminologies and classification systems will provide much better data for:

• Measuring the quality, safety, and efficacy of care
• Designing payment systems and processing claims for reimbursement
• Conducting research, epidemiological studies, and clinical trials
• Setting health policy
• Operational and strategic planning and designing healthcare delivery systems
• Monitoring resource utilization
• Improving clinical, financial, and administrative performance
• Preventing and detecting healthcare fraud and abuse
• Tracking public health and risks

The quality and usefulness of this coded data depends upon sufficient maintenance of the code set standards themselves and consistent and appropriate application of the codes in practice. AHIMA is actively involved in the following efforts in support of quality coded data.

• Represents and serves AHIMA members at the national level by promoting uniformity of health care data by collaborating on the establishment of coding and classification standards and guidelines across health care settings.
• Represents AHIMA members' needs by recommending revisions to the Centers for Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS) that ensure that the classification remains current, viable, and robust.
• Represents AHIMA members at key standards development organizations including ISO, WHO-FIC, HL7 International, and IHTSDO.
• Provides educational coding resources so that providers have well-trained, well-informed coders to allow appropriate capture of information.
• Is involved in endeavors that rely on the use and interpretation of data including development of standards, implementation, and enforcement not only in the inpatient and outpatient setting but post acute care settings, such as long term care and home care, as well because clinical terminologies and classification systems comprise the core of the information infrastructure.

Code set maintenance and development of the associated rules and guidelines are the responsibility of the medical code set maintenance organizations. AHIMA is working with these code set maintenance organizations in many ways.

Cooperating Parties for ICD-9-CM

The Official ICD-9-CM Guidelines for Coding and Reporting have been developed and approved by the four organizations that make up the Cooperating Parties for the ICD-9-CM. AHIMA is one of the cooperating parties along with the American Hospital Association, CMS, and NCHS.

The four cooperating parties, approve not only the ICD-9-CM Official Guidelines for Coding and Reporting but also the ICD-10-CM Official Guidelines for Coding and Reporting, the coding advice published by AHA in the Coding Clinic for ICD-9-CM, and the coding advice published by AHA in the Coding Clinic for HCPCS.

ICD Code Set Maintenance - Coordination and Maintenance Committee

Two federal agencies, the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS), maintain ICD-9-CM. The classification of diagnoses (volumes 1 and 2) is maintained by NCHS and procedures (volume 3) by CMS.

Representatives from these two agencies co-chair the ICD-9-CM Coordination and Maintenance Committee, an advisory body that holds public meetings to discuss possible updates and revisions to ICD-9-CM. AHIMA regularly participates in these Coordination and Maintenance Committee meetings and submits comments on the proposals. Suggestions for code modifications are received from both the public and private sectors. Comments are encouraged both at the meetings and in writing.

• Coordination and Maintenance Committee Meetings
• CMS C&M Website 
• NCHS C&M Website

The ICD-9-CM coding system has potential to be updated twice a year, April 1 and October 1. Information on updates to the diagnosis section is posted on the NCHS website. Information on ICD-9-CM procedure code updates is posted on the CMS website.

• Requesting New/Revised  ICD-9-CM Procedure Code Changes (CMS)

It is anticipated that the same process will be used for maintenance of the ICD10-CM and ICD-10-PCS coding systems. And AHIMA will continue to participate in these meetings and work to positively influence code change proposals.

CPT Code Set Maintenance

The AMA’s CPT® Editorial Panel is responsible for maintaining the CPT® code set, with the support of the CPT® Advisory Committee. AHIMA participates in the CPT® Editorial Panel’s meetings and deliberations. The editorial panel meetings are open to the public. The AMA updates CPT® codes on an annual basis and changes are effective on January 1.

• Code changes for CPT (AMA)

Resources and Links

Guidelines for ICD Coding and Reporting

• The ICD-9-CM Official Guidelines for Coding and Reporting should be used as a companion document to the official version of ICD-9-CM as published on CD-ROM by the US Government Printing Office (GPO).
• The ICD-10-CM Official Guidelines for Coding and Reporting
• TheICD-10-PCS Reference Manual is also available

• AHA and Process for Submitting Coding Questions
• Subscribe to AHA Coding Clinic for ICD-9-CM

CPT Codes

• New CPT® Category I Vaccine product codes, Category II, and Category III codes are added throughout year to the AMA Web site. The code updates on this website identify those codes that have been added since the latest printing of the CPT® coding manual.
• View the process to submit new codes or changes to the CPT® nomenclature

• Learn more about the process to request a new CMS HCPCS Level II code or obtain the latest updates
• Central Office on HCPCS and Submitting Coding Questions
• Information on AHA’s coding clinic for HCPCS