HHS Issues Final ICD-10 Code Sets and Updated Electronic Transaction Standards Rules

The U.S. Department of Health and Human Services (HHS) recently released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.

The first final rule replaces the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets. The compliance date for this replacement is October 1, 2013.

The second final rule adopts an updated X12 standard, Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard. The sunset date for current X12 transactions is 12/31/2011.