ICD-10 Final Regulation & Training

On January 16, 2009, the Department of Health and Human Services published the final regulation (45 CFR 162.1002) that adopted the ICD-10-CM and ICD-10 PCS code sets as HIPAA standards. This rule required the use of the ICD-10 code sets in all HIPAA transactions. The compliance date published in the final rule is October 1, 2013. Since ICD-10 code sets are medical code sets, the compliance date indicates the date of service for which these codes must be used. So, the ICD-10 code sets must be used in transactions when the service date in the transaction is on or after October 1, 2014. 

Because this is a federal mandate, all health plans, clearinghouses, and providers using electronic transactions must transition to the ICD-10 code sets on the compliance date, not before. This transition impacts Medicaid Management Information System (MMIS) replacement projects, Medicaid Electronic Health Record (EHR) Incentive Programs, and other system conversion projects between now and 2014.

Additional information is available:

State Medicaid Agencies Must Use ICD-10 Code Sets by October 1, 2014

As HIPAA covered entities, states must comply with use of the ICD-10 codes sets by the October 1, 2014 deadline established by CMS.

To help states implement ICD-10, CMS has developed an ICD-10 training package for State Medicaid agencies. The complete package includes 12 training segments that address federal requirements and other aspects of ICD-10 implementation.

The training is a high-level review, intended primarily for state Medicaid managers, that focuses on assessment and planning, not the "nuts and bolts" of implementation. The 12 segments address the following topics:

  1. What Is ICD-10?
  2. Regulatory Requirements
  3. Benefits of Using ICD-10
  4. Further Movement Along the MITA Roadmap – Use of Clinical Data and Interoperability
  5. Effective Implementation of ICD-10
  6. Potential Programmatic and Technical Problems
  7. Impact on MITA Business Processes
  8. Forming the Implementation Team
  9. The Implementation Team that Gets It Right
  10. Where Are You In This Process and Timeline?
  11. Partner and Vendor Considerations
  12. Post Compliance Date Actions and Education and Training Processes