This section will give health care providers the information needed to comply with
the HIPAA migration from ICD-9-CM to ICD-10-CM and ICD-10-PCS when engaging in claims-related
data interchange with Arkansas Blue Cross and Blue Shield. By law, all HIPAA covered
entities that send claims to Arkansas Blue Cross must begin using the ICD-10 code
sets on Oct. 1, 2013. Visit the ICD-10 Resource Center often for the latest information.
For the past 30 years, ICD-9 has been the code set used to report diagnoses and
procedures in administrative transactions. There are three volumes of ICD-9-CM.
Volumes 1 and 2 contain the codes for reporting diagnoses and symptoms. Volume 3
contains the codes for reporting surgical and nonsurgical procedures in hospital
On Jan. 16, 2009, the Department of Health and Human Services (HHS) published a
regulation requiring the replacement of ICD-9 with ICD-10 on Oct. 1, 2013. The regulation
names ICD-10-CM for reporting diagnoses in all clinical situations and ICD-10-PCS
for procedures as appropriate.
ICD-10 is replacing ICD-9 as a HIPAA-named code set. Therefore, covered entities,
defined in HIPAA (and expanded in the ARRA) as health care providers, health plans,
and health care clearinghouses, are required to comply with this regulation.
Impact To You
The implementation of ICD-10 codes will require substantial changes to the files,
software, systems and procedures that currently use ICD-9 codes when billing Medicare,
Medicaid and Private payers. This may include changes to electronic health records
(EHRs), practice management systems (PMS), super bills, remittance information,
as well as ICD-10 code set training for you and your staff. So it is extremely important
that you are aware of these HIPAA-named code set changes and make plans for their
What You Need To Know
The Administrative Simplification Compliance Act (ASCA) requires the use of ICD-10
codes effective Oct. 1, 2013. Therefore, if you send a file that contains ICD diagnoses
and procedure codes, your files must be modified to include ICD-10 codes of ICD-9
codes. As a covered entity, Arkansas Blue Cross must accept and send ICD-10 codes
when using electronic transactions covered under HIPAA. Arkansas Blue Cross’s strategy
is to use ICD-10 codes when exchanging claims-related data with any of its external
trading partners. Arkansas BlueCross will provide additional information to assist
you and keep you apprised of progress on our implementation of ICD-10 code sets
through a variety of communication vehicles. Remember that the HIPAA standards,
including the use of HIPAA-named code sets, are national standards and apply to
your transactions with other covered entities.
What You Need To Do
Given the extensive nature of the changes this law mandates, the lead-time to address
this regulation is actually very short. You are encouraged to begin preparing for
the implementation of these new ICD-10 code sets requirements in your daily clinical
and business operations. Implementation of the X12 Version 5010 and NCPDP Version
D.0 standards are a prerequisite for implementing the new ICD-10 code sets. Information
regarding the progress of Arkansas Blue Cross’s implementation of HIPAA 5010 can
be found on this website under 5010 Resource Center. If you haven't already done
so, contact your billing vendors, software vendors and clearinghouse to inquire
about their plans for ICD-10 readiness.
Centers for Medicare & Medicaid Services
Workgroup for Electronic Data Interchange
American Health Information Management Association