The latter proposes adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as healthcare claims.
Under HIPAA in 2000, the ICD-9-CM code sets were adopted for use in the administrative transactions by both the public and private sectors to report diagnoses and inpatient hospital procedures. Covered entities required to use the ICD-9-CM code sets include health plans, healthcare clearinghouses, and healthcare providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures, HHS says.
The ICD-10 code sets proposed rule would concurrently adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. The new codes would replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
Updated versions of current HIPAA electronic transaction standards require the use of the ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorization, and other widely used transactions. The currently adopted standard, Version 4010/4010A1 of the American Standards Committee X12 group, cannot accommodate the much larger ICD-10 code sets. Under the updated transaction standards proposed rule, compliance with Version 5010 (healthcare transactions) and Version D.0 (pharmacy claims) would be required by April 1, 2010.
View both regulations. Comments on both the ICD-10 code sets and updated transaction standards proposed rules are due by 5 p.m. Eastern on Oct. 21.
