Why ICD-10?

There were four main reasons that the federal government moved to ICD-10 as a code set standard: (1) ICD-9 dates to 1979 and its functionality has been “exhausted” and does not reflect “new and changing medical advancements”; (2) Parts of the ICD-9-CM were full, which required putting codes in “topically unrelated chapters,” burdensome for healthcare providers in a move toward more efficiency; (3) Insufficient detail opportunities: “[I]n an age of electronic health records, it does not make sense to use a coding system that lacks specificity and does not lend itself well to updates…Emerging health care technologies, new and advanced terminologies, and the need for interoperability amid the increase in…

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Classification Coding Systems

ICD-10 diagnosis and procedure codes are “classification coding systems” useful for conducting administrative transactions. SNOMED-CT® (Systematized Nomenclature of Medicine–Clinical Terms) is a “clinically complex terminology standard” designed for the primary documentation of clinical care that will enhance interoperability with electronic health record (EHR) systems. According to the preamble of the proposed ICD-10 rule published on August 22, 2008, “The benefits of using SNOMED-CT® increase if it is linked to a classification system such as ICD-10-CM and ICD-10-PCS for the purpose of generating health information that is necessary for statistical analysis and reimbursement. The use of both SNOMED-CT® and ICD-10-CM and ICD-10-PCS brings value to the development of interoperable electronic health…

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Migrating to ICD-10

Under the final ICD-10 rule, all healthcare providers will utilize ICD-10-CM to code diagnoses beginning October 1, 2013. For procedure coding under the final ICD-10 rule, physicians and all healthcare providers other than inpatient hospitals will continue to use the current procedure coding standard: Current Procedural Terminology, 4th Edition (CPT-4) and the Healthcare Common Procedure Coding System (HCPCS). Inpatient hospital services procedures will be coded using ICD-10-PCS codes, which provide facility related procedure codes suitable to inpatient environments.

HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS

Standards. The final rule adopts modifications to two code set standards in the Transactions and Code Sets final rule that required compliance by covered entities on or after October 16, 2003. The new final rule, published in the Federal Register on January 16, 2009, modifies standard medical data code sets for coding diagnoses (ICD-10-CM) and inpatient hospital procedures (ICD-10-PCS). ICD-10-CM means International Classification of Diseases, 10th Revision, Clinical Modification for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, as maintained and distributed by the U.S. Department of Health and Human Services (HHS). ICD-10-PCS means International Classification of Diseases, 10th Revision, Procedure Coding System for inpatient hospital procedure…

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New HIPAA Standard Transaction Rules Released

On Friday, January 16, 2009, the Office of the Secretary of the Department of Health and Human Services published in the Federal Register final rules pertaining to: Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards (74 Federal Register 3295-3328); and, HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS (74 Federal Register 3328-3362).

Final ICD-10 Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 162 | [CMS–0013–F] | RIN 0958–AN25 HIPAA Administrative Simplification; Modifications to the Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS AGENCY: Office of the Secretary, HHS. ACTION: Final rule. Download (Requires Acrobat Reader)

Proposed Rule for Electronic Claims Attachments

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 162 | [CMS–0050–P] | RIN 0938–AK62 HIPAA Administrative Simplification: Standards for Electronic Health Care Claims Attachments AGENCY: Office of the Secretary, HHS. ACTION: Proposed rule. Download (Requires Acrobat Reader)

Final Transactions Rule Corrections

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 160 and 162 | [HCFA0149CN] | RIN 0938AI58 Health Insurance Reform: Standards for Electronic Transactions; Correction AGENCY: Office of the Secretary, HHS. ACTION: Correction of final rule. Download (Requires Acrobat Reader)

Final Transactions Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 160 and 162 | [HCFA–0149–F] | RIN 0938–AI58 Health Insurance Reform: Standards for Electronic Transactions AGENCY: Office of the Secretary, HHS. ACTION: Final rule. Download (Requires Acrobat Reader)

Proposed ICD-10 Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 160 and 162 | [CMS–0013–P] | RIN 0958–AN25 HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS AGENCY: Office of the Secretary, HHS. ACTION: Proposed rule. Download (Requires Acrobat Reader)