HHS seeks to improve disease tracking
As expected, the Department of Health and Human Services (HHS) in August announced a proposed regulation that would replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets. If adopted, the new regulation would take effect in October 2011.
In announcing the proposed regulation change, HHS described the expanded ICD-10 code sets as necessary to fully support quality reporting, pay-for-performance, bio-surveillance, and other activities. Conversion to ICD-10 is essential to development of a nationwide electronic health information environment, HHS Secretary Mike Leavitt said in prepared comments.
In a separate proposed regulation, HHS seeks to adopt 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, the department explains.
The ICD-9-CM code sets were adopted in 2000 for use in administrative transactions by both the public and private sectors to report diagnoses and inpatient hospital procedures. Health plans, health care clearinghouses, and health care providers who transmit any electronic health information in connection with transactions covered by HHS standards are required to use the ICD-9-CM code sets.
But ICD-9 was developed nearly 30 years ago, and it is widely viewed as outdated because of its limited capacity for accommodating new procedures and diagnosis. ICD-9 contains 17,000 codes, and is expected to start running out of available codes in 2009. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a slew of new diagnoses and procedures.
Updated versions of current Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards require the use of the ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorization, and other widely used transactions. The currently adopted standard, Version 4010/4010A1 of the American Standards Committee X12 group, can't accommodate the much larger ICD-10 code sets.
Under the updated transaction standards proposed rule, compliance with Version 5010 (health care transactions) and Version D.0 (pharmacy claims) would be required by April 1, 2010. That rule proposes a standard for the Medicaid pharmacy subrogation transaction, the process by which state Medicaid agencies recoup funds for payments they've made for pharmacy services for Medicaid recipients in cases where another third-party payer has primary financial responsibility. Compliance would be required two years after the effective date of the final rule, except for small health plans, which would have an additional year.
To review both regulations, see www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage. Comments on the ICD-10 code-sets proposed rule are due by 5 p.m. ET, October 21, 2008. Comments on the updated transaction standards proposed are due by 5 p.m. ET on October 21, 2008.
As expected, the Department of Health and Human Services (HHS) in August announced a proposed regulation that would replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets. If adopted, the new regulation would take effect in October 2011.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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