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.
Update: On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted,
which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health
and Human Services expects to release an interim final rule in the near future that will include a new compliance date
that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to
continue to use ICD-9-CM through September 30, 2015.
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.
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.
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.
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. If you haven’t already done so, contact your billing vendors, software vendors and clearinghouse to
inquire about their plans for ICD-10 readiness.
Arkansas Blue Cross and Blue Shield is actively engaged in ICD-10 end-to-end testing
with providers. We encourage you to schedule your ICD-10 testing with us. For further
details, please contact our ICD-10 team at firstname.lastname@example.org.
Centers for Medicare & Medicaid Services
Workgroup for Electronic Data Interchange
American Health Information Management Association
CMS: Road to 10: The Small Physician Practice's Route to ICD-10
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Shield Association and is licensed to offer health plans in all 75 counties in Arkansas.
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