Health Insurance Portability and Accountability Act (HIPAA) transaction code set updates will soon be implemented to update field spaces from 4010 to 5010. Soon after these electronic format updates are in place, there will be a major move to ICD–10–CM to replace the long-used ICD–9–CM. The information below should provide your office with a general explanation of the changes, as well as guidance to help ensure your practice is ready to comply with the updates.
5010 Codes
5010 is the next generation of the HIPAA transaction and code set changes (ANSI X12 5010), replacing the 4010 transaction set implemented in the late 1990s.
ICD–10 Codes
ICD–10–CM (diagnosis codes) and ICD–10–PCS (procedure codes) will replace the ICD–9 code set implemented in 1977 by the World Health Organization.
On January 16, 2009, the final rule was announced for these updates to replace the current Version 4010/4010A and for National Council for Prescription Drug Programs codes Version 5.1. Implementation will begin January 1, 2011, with completion of the update by January 1, 2012. IDC–10–CM has an effective date of October 1, 2013, and is expected to be implemented by physicians, hospitals and other health care providers to identify diagnoses for documentation, medical records and claims.
The possible impacts on your practice:
- Hardware, software and forms used for claims development will need to be upgraded or replaced.
- Coding education for ICD–10–CM and coding software upgrades or replacement will need to occur prior to the October 1, 2013, effective date.
- Data analyses, population health trending reports and other analytics will need modification.
Benefits
ICD–10–CM allows space to accommodate future expansion of the ranges of diagnoses and procedures and will provide greater coding accuracy and specificity. This enhanced accuracy means providers should see a reduction in coding errors. The shift to ICD–10–CM also creates the ability to gather higher quality health care, safety and efficiency data, which can support advances in medicine and technology.
For more information about the upcoming changes to 5010 and ICD–10–CM, visit one of the following Web sites.
Centers for Medicare and Medicaid Services (CMS) Web site:
www.cms.gov
CMS HIPAA Web site:
www.HIPAA.org
The Accredited Standards Committee Web site:
www.x12.org
Workgroup for Electronic Data Interchange Web site:
www.wedi.org/public/articles/index.cfm
Humana Military and our claims processor, PGBA, are currently preparing for 5010 and the anticipated ICD–10–CM updates.
