HHS Proposes Adoption of ICD-10 Code Sets and Updated Electronic Transaction Standards

On September 18, 2008, the Department of Health and Human Services (HHS) made a long awaited announcement regarding ICD-10-CM. On Friday, a proposed regulation was announced that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011. In a separate proposed regulation, HHS has proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as health care claims. Version 5010 is essential to use of the ICD-10 codes.

Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures. The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions.

Comments on the ICD-10 code sets proposed rule are due by 5:00pm Eastern time on October 21, 2008.

Comments on the updated transaction standards proposed are due by 5:00pm Eastern time on October 21, 2008.

Both regulations may be viewed at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp.

To read the HHS press release issued, please click here: http://www.hhs.gov/news/press/2008pres/08/20080815a.html.

Fact sheets describing both proposed rules will be forthcoming at http://www.cms.hhs.gov/apps/media/fact_sheets.asp.

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