ICD-10 Resource Center


This section will give health care providers the information needed to comply with the HIPAA migration from ICD-9-CM to ICD-10-CM and ICD-10-PCS when engaging in claims-related data interchange with Arkansas Blue Cross and Blue Shield. By law, all HIPAA covered entities that send claims to Arkansas Blue Cross must begin using the ICD-10 code sets on Oct. 1, 2014. Visit the ICD-10 Resource Center often for the latest information.

Background

For the past 30 years, ICD-9 has been the code set used to report diagnoses and procedures in administrative transactions. There are three volumes of ICD-9-CM. Volumes 1 and 2 contain the codes for reporting diagnoses and symptoms. Volume 3 contains the codes for reporting surgical and nonsurgical procedures in hospital inpatient settings.

On Jan. 16, 2009, the Department of Health and Human Services (HHS) published a regulation requiring the replacement of ICD-9 with ICD-10 on Oct. 1, 2013. The regulation names ICD-10-CM for reporting diagnoses in all clinical situations and ICD-10-PCS for procedures as appropriate.

ICD-10 is replacing ICD-9 as a HIPAA-named code set. Therefore, covered entities, defined in HIPAA (and expanded in the ARRA) as health care providers, health plans, and health care clearinghouses, are required to comply with this regulation.

Update: On August 24, 2012, Kathleen Sebelius, secretary of the U.S Department of Health and Human Services (HHS), announced a final ruling providing a one-year delay in the compliance date (from October 1, 2013 to October 1, 2014) for use of the ICD-10 CM diagnosis and procedure codes.

Impact To You

The implementation of ICD-10 codes will require substantial changes to the files, software, systems and procedures that currently use ICD-9 codes when billing Medicare, Medicaid and Private payers. This may include changes to electronic health records (EHRs), practice management systems (PMS), super bills, remittance information, as well as ICD-10 code set training for you and your staff. So it is extremely important that you are aware of these HIPAA-named code set changes and make plans for their implementation.

What You Need To Know

The Administrative Simplification Compliance Act (ASCA) requires the use of ICD-10 codes effective Oct. 1, 2014. Therefore, if you send a file that contains ICD diagnoses and procedure codes, your files must be modified to include ICD-10 codes of ICD-9 codes. As a covered entity, Arkansas Blue Cross must accept and send ICD-10 codes when using electronic transactions covered under HIPAA. Arkansas Blue Cross’s strategy is to use ICD-10 codes when exchanging claims-related data with any of its external trading partners. Arkansas BlueCross will provide additional information to assist you and keep you apprised of progress on our implementation of ICD-10 code sets through a variety of communication vehicles. Remember that the HIPAA standards, including the use of HIPAA-named code sets, are national standards and apply to your transactions with other covered entities.

What You Need To Do

Given the extensive nature of the changes this law mandates, the lead-time to address this regulation is actually very short. You are encouraged to begin preparing for the implementation of these new ICD-10 code sets requirements in your daily clinical and business operations. Implementation of the X12 Version 5010 and NCPDP Version D.0 standards are a prerequisite for implementing the new ICD-10 code sets. Information regarding the progress of Arkansas Blue Cross’s implementation of HIPAA 5010 can be found on this website under 5010 Resource Center. If you haven’t already done so, contact your billing vendors, software vendors and clearinghouse to inquire about their plans for ICD-10 readiness.

Additional Information

Centers for Medicare & Medicaid Services
Workgroup for Electronic Data Interchange
Gartner
American Health Information Management Association