HHS to adopt ICD-10 codes, update HIPAA 5010 rule

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HHS implements new codes and adopts updated HIPAA rule. Source: South Carolina Hospital Association  

The Department of Health and Human Services (HHS) Friday released two proposed rules to adopt updated standards for HIPAA transaction sets and to replace the ICD-9 codes for diagnoses and procedures by October 2011.

The changes outlined in proposed regulations were published by the Centers for Medicare & Medicaid Services (CMS), which is accepting public comments on the regulations through Oct. 21.

In one rule, HHS has proposed to adopt the ICD-10 code set to replace the ICD-9 code sets in HIPAA transactions.  ICD-10 has space for more than 155,000 codes, which allows for more specificity and detail. The current ICD-9 code set is limited to 17,000 codes and by next year, it will be difficult to find slots for new diseases and procedures, according to Government Health IT.

In the second rule, the department has proposed to adopt X12 Version 5010 and NCPDP Version D.0 for the same transactions. Within this rule, HHS also proposes to adopt a new standard for Medicaid subrogation for pharmacy claims, known as NCPDP Version 3.0. Version 5010 accommodates the ICD-10 code sets, and has an earlier compliance date than ICD-10 to ensure adequate testing time for the industry.

CMS said that the use of these standard transactions and code sets will improve Medicare and Medicaid programs, Federal health programs and private health programs, and the effectiveness and efficiency of the healthcare industry in general, by simplifying the administration of the system and enabling the electronic transmission of certain health information.

The proposed rules are currently on display in the Federal Register and will be published on Aug. 22, the agency said.