HIPAA 5010 and ICD10

On April 1, 2014 the president signed a bill into law that addresses a variety of health policy issues, including a delay in the transition from ICD–9 to ICD–10 code sets. The new code set was adopted 10/1/2015.

On January 15, 2009, the Department of Health and Human Services (HHS) released two final rules under the Administrative Simplification Provision of the Health Insurance Portability and Accountability Act (HIPAA) that will facilitate the United States’ ongoing transition to an electronic health care environment through the adoption of:

  • Updated standards for electronic health care and pharmacy transactions (5010) – effective January 1, 2012.
  • New diagnosis and procedure coding standards – that is, the ICD-10-Clinical Modification (CM) and ICD-10-Procedure Coding System (PCS) – effective October 1, 2013. A revised compliance date of October 1, 2014 (ICD-10, 5010 and National Provider Identifier (NPI) was proposed on April 9, 2012.

The covered entities who must comply with the transaction and new coding standards are health care providers, health plans and health care clearinghouses. The scope for ICD-10 remediation includes more than 100,000 new diagnosis and procedure codes which will allow for greater specificity about the services represented. The new codes are expected to meet the increased level of detail needed to recognize advancements in medicine and technology, and will bring the United States in line with the majority of the developed world. Concerns that the current ICD-9 terminology and classifications of some conditions are outdated and inadequate have been cited as the primary reasons for the conversion to ICD-10. This is a unique and challenging time in healthcare. The implementation of ICD-10-CM/PCS in America is anticipated to improve the capture of healthcare information and bring the United States in step with the medical diagnosis coding systems worldwide.