Proposed Changes Would Improve Disease Tracking and Speed Transition

 to an Electronic Health Care Environment

The Department of Health and Human Services (HHS) today announced a long-awaited proposed regulation 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.

In 2000, under authority provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the ICD-9-CM code sets were adopted for use in the administrative transactions by both the public and private sectors to report diagnoses and inpatient hospital procedures.  Covered entities required to use the ICD-9-CM code sets include health plans, health care clearinghouses, and health care providers who transmit any electronic health information in connection with a transaction for which a standard has been adopted by HHS.

Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses.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 www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage

To read the HHS press release issued please click here or see attached : http://www.hhs.gov/news/press/2008pres/2008.html

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