Word from Washington
Aligning ICD- 10
Federal Initiatives Recognize the Value of Integration
By Dan Rode, MBA, CHPS, FHFMA
THE THEME OF this month’s Journal is
very timely on two accounts. First, the
process for implementing ICD-10-CM/
PCS is heating up as the industry is now
six months from what many consider the
first national milestone: the January 2012
compliance deadline for the HIPAA 5010
transaction upgrade. Second, the federal government is aligning its initiatives,
including the Centers for Medicare and
Medicaid Services’ accountable care organization program and the value-based
purchasing final rule, with the ICD-10-
Although the compliance deadline
is still more than two years away, the
healthcare industry is recognizing the
need to integrate ICD- 10 into a number
of developing initiatives.
In most covered entities and system vendors, significant efforts are under way
to meet the year-end deadline for the
HIPAA 5010 transaction upgrade. The
upgrade has been difficult because it involves updating approximately 800 components that have accumulated over the
10-plus years since the original transaction standards were published. Although
some parts of the upgrade will be apparent only to electronic data interchange
programmers, quite a number will make
using the suite of HIPAA transactions
easier and more efficient.
The upgrade’s impact on HIM professionals will depend on their organizations’ claims and application systems.
However, several changes will definitely
affect the HIM profession.
The most noted change is that covered transactions will be able to define
the classification sets in the transaction,
which in turn will allow ICD- 10 codes to
be recognized. This sets the stage for the
ICD- 10 conversion.
Second, health plans such as CMS will
be able to accept all diagnostic and procedure codes associated with ICD-9-CM
and ICD-10-CM/PCS and will no longer
need to limit the number of codes submitted to nine diagnostic and six procedure codes, which was dictated by old
paper format restrictions. The ability to
send all the codes associated with an
admission or encounter could have a
significant impact on providers of secondary and tertiary service reimbursement.
Some organizations are running behind
on the upgrade to the HIPAA 5010 transaction standard. Come January 2012,
organizations that have not updated to
the new standard could be penalized. In
most cases health plans have indicated
that they will reject noncompliant claims
or other transactions.
There are a few exceptions to the January 2012 deadline. A few Medicaid Medical Information Systems scheduled to be
replaced may not be installed by January
1, 2012. However, even in these cases,
providers and health plans or their clearinghouses must be prepared to supply
the additional information expected in
the upgraded HIPAA transactions. Likewise, CMS has indicated that it will not
be extending payments to providers that
are not ready for the HIPAA transaction
CMS and several of the larger health
plans have also indicated their readiness
to begin testing the 5010 transactions
this month, and provider organizations
should be clear on their testing plans between now and the end of the year.
HIM professionals should be aware of
their organization’s progress in meeting the transaction deadline. Readers
can consult AHIMA’s ICD- 10 Web site
www.ahima.org/icd10 and www.Get-
Ready5010.com for more information.