Update on ICD-10 Code Sets and Standards Governing Electronic Transactions

On January 15, the U.S. Department of Health and Human Services released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of an updated set of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.

In accordance with the White House Chief of Staff’s memorandum of January 20, 2009, titled “Regulatory Review,” a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.

• The first rule finalizes new code sets to be used for reporting diagnoses and procedures on health care transactions. This final rule replaces the ICD-9-CM code sets, developed nearly 30 years ago, with greatly expanded ICD-10 code sets.
• The second final rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996. The updated versions replace the current standards and will promote greater use of electronic transactions.

In response to public comments suggesting that more time would be needed for effective industry implementation, the final rules include later compliance dates.

More specifically, the final rules provide compliance dates of Jan. 1, 2012, for the transaction standards and Oct. 1, 2013, for the ICD-10 code sets.