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Implementing the ICD-10-CM Diagnosis Code Data Set

    • On Oct. 1, 2015, physicians and their practices will be required to use the ICD-10-CM diagnosis code data set. The new data set was adopted by the Centers for Medicare & Medicaid Services (CMS) and complements initiatives of the American Recovery & Reinvestment Act of 2009. Adoption of ICD-10-­CM is mandatory.


      The ICD-­10-­CM diagnosis code data set:

      • More accurately represents disease processes
      • More clearly defines episodes of care
      • Allows for biosurvellience and quality reporting
      • Better represents current and emerging technologies

      Under the Administrative Simplification Rules of the Health Insurance Portability & Accountability Act of 1996 (HIPAA), CMS originally established electronic healthcare transaction standards and stipulated a designated diagnosis code data set to be used by all HIPAA-­covered entities in transmitting claims and performing related operations (initially known as the ASC X12 Version 4010/4010A format and the ICD-­9-­CM diagnosis code data set for physician practices).

      In order to transmit and receive electronic claims and health-­‐related data containing ICD-­10-­CM diagnosis codes, practices will need to upgrade their practice management systems to the ASC X12 Version 5010 format by Jun. 30, 2012. The new 5010 format expands fields of the former electronic claim to accommodate the expanded diagnosis code data set and allows ease of transmission to payers and other third party entities involved with claims review and adjudication. Electronic health record systems may also need upgrading, as diagnosis codes are used by EHRs to generate patient problem lists and to report quality measures.

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