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ICD-10 Impact to HIPAA Transactions

August 07, 2013

Introduction
The implementation of ICD-10 is a project unlike any that the health care industry has attempted in the last 20 years. This project impacts virtually every business process and system in health plans, provider facilities, clearinghouses, and vendors. The breadth and depth of this project means that the risks for the entire value chain are enormous. As part of the testing process for ICD-10, it is imperative that we have a clear understanding of where the ICD-10-CM and ICD-10-PCS codes are used in the transactions required under HIPAA and used in the health care industry to exchange diagnosis and procedure information. This issue brief is a joint effort between WEDI and ASC X12 Inc.and is designed to help the industry better understand where to focus the transaction testing and to ensure that appropriate changes are implemented prior to beginning the testing and implementation of the new code sets.

The implementation of ICD-10 is a project unlike any that the health care industry has attempted in the last 20 years. This project impacts virtually every business process and system in health plans, provider facilities, clearinghouses, and vendors. The breadth and depth of this project means that the risks for the entire value chain are enormous. As part of the testing process for ICD-10, it is imperative that we have a clear understanding of where the ICD-10-CM and ICD-10-PCS codes are used in the transactions required under HIPAA and used in the health care industry to exchange diagnosis and procedure information. This issue brief is a joint effort between WEDI and ASC X12 Inc.and is designed to help the industry better understand where to focus the transaction testing and to ensure that appropriate changes are implemented prior to beginning the testing and implementation of the new code sets.

Purpose of this Issue Brief
The purpose of the Issue Brief is to provide information on the transactions that are impacted by ICD-10 as well as the placement of the codes within the transactions. Knowing where all of the touch points are will help facilitate implementation and testing of ICD-10-CM and ICD-10-PCS.

Although it can be argued that implementation of version 5010 of the ASC X12 transactions tested the format that will be used to carry ICD-10 codes, the industry did not focus on assuring the codes were correctly assigned and reflected on transactions or that transactions carrying ICD-10 codes were correctly processed in front end or downstream applications. This document will help highlight the transactions and content that will need to be validated as part of the ICD-10 testing effort. Testing might include verification that transaction and code formats are correct, codes are valid, number of occurrences is appropriate, etc.

This document can also be used as input to an ICD-10 impact assessment and subsequent remediation planning.