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HIPAA 5010 and the ICD-10-CM/PCS Implementations
On January 16, 2009, the Department of Health and Human Services (HHS) published two final rules to update the Health Insurance Portability and Accountability Act (HIPAA) standards. The first replaces the ICD-9-CM code sets now used, with the expanded ICD-10 code sets to report health care diagnosis and procedures. The second replaces the current X12 Version 4010/4010A1 standard with Version 5010 for certain health care transactions.
The updated X12 transaction standard, Version 5010, provides the framework needed to support the ICD-10 code sets. Therefore, it is extremely important that providers are aware of these upcoming changes and plan for their implementation.
Version 5010
The X12 Version 5010 includes updated standards for claims, remittance
advice, eligibility inquiries, referral authorization, and other administrative
transactions. Version 5010 also accommodates the use of the ICD-10
code sets, which are not supported by the current X12 standard (Version
4010/4010A1). Effective January 1, 2012, providers must be ready
to submit claims electronically using the X12 Version 5010 standard. The
Special Edition article, SE0904 provides
an introductory overview of the HIPAA 5010 implementation. Additionally,
more information can be found on the Centers for Medicare & Medicaid
Services (CMS) 5010
D.0 Web page or the Versions
5010 & D.0 & 3.0 Web page.
Additional Version 5010 Resources
- Additional
Instruction for Implementation of Health Insurance Portability and
Accountability Act of 1996 (HIPAA) Version 5010 for Transaction 835
- Health Care Claim Payment/Advice and Updated Standard Paper Remit
(SPR) Medicare Learning Network (MLN) Matters article MM6975.
- Preparing
for Electronic Data Interchange (EDI) Standards: The Transition
to Versions 5010 and D.0 Fact Sheet
- 5010 National
Calls
ICD-10-CM/PCS
The ICD-10 codes sets contain more than 155,000 codes and accommodate a
host of new diagnoses and procedures. The compliance date for implementation
of the ICD-10-CM/PCS Coding System is October 1, 2013 for all covered
entities. The Special Edition article, SE0832 outlines
general information for providers detailing the International Classification
of Diseases, 10th Edition (ICD-10) classification system. In addition,
more detailed information is available on the CMS Web site at: http://www.cms.gov/ICD10/01_Overview.asp
Additional ICD-10-CM/PCS Resources
- Centers for Medicare & Medicaid Services (CMS) Sponsored ICD-10-CM/PCS
Calls
- ICD-10
Implementation Information Special Edition Medicare Learning Network
(MLN) Matters article SE1019
- The following organizations offer providers and others ICD-10 resouces:
- ICD-10
National Calls
Page last updated: July 15, 2010
