HHS Announces ICD-10 Final Rules

The U.S. Department of Health & Human Services (HHS) has announced two final rules said to 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 involves the replacement of current ICD-9-CM code sets with a new and expanded ICD-10-CM code set. International Classification of Diseases and Related Health Problems, Clinical Modification (ICD) codes are used to identify various medical diagnoses and procedures. ICD codes are used by health-care providers and payors.

The second final rule adopts updated versions of standards for electronic health-care transactions to "promote greater use of electronic transactions," according to an HHS news release.

The compliance date for the ICD-10 code set rule is Oct. 1, 2013.

The development of the two rules are being coordinated because the current electronic transaction standards cannot accommodate the new and much larger ICD-10 set of codes. The ICD codes were expanded to be able to cover a great number of new and future medical conditions and procedures. HHS has called the ICD-9-CM code set "outdated with only a limited ability to accommodate new procedures and diagnoses." ICD-9-CM codes also lack "the precision needed for a number of emerging uses such as pay-for-performance and biosurveillance."

HHS says ICD-10 code sets will "support value-based purchasing and Medicare's anti-fraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information."

To read the final rules in the Federal Register, click HERE.


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