Blues: ICD-10, 5010 Dates = Meltdown

HDM Breaking News, September 8, 2008

The federal government's proposed deadlines for implementing the ICD-10 diagnosis and procedure code sets and HIPAA 5010 transaction standards "will result in a major meltdown in the health care industry," according to Scott Serota, president and CEO of the Blue Cross and Blue Shield Association in Chicago.

The Department of Health and Human Services last month proposed rules to implement 5010 by April 2010 and ICD-10 by October 2011. Doing so, Serota said in a recent statement, would result in inaccurate and delayed payments, an inability to detect fraud and abuse, and unnecessarily higher implementation costs because of the accelerated timeline.

The association calls on HHS to adopt the timeline recommended by the National Committee for Vital and Health Statistics--an advisory body to HHS--to implement HIPAA 5010 first followed by ICD-10. "If the NCVHS process were followed and started now, the soonest ICD-10 could be completed is late 2013," according to the association's statement.

In a media briefing, the association noted that modifications under HIPAA 5010 are "massive" with more than 850 complex changes to the existing transaction sets. Further, the ICD-10 code sets are vastly larger than the ICD-9 sets now used. For instance, ICD-9 has four diagnosis codes for sprained and strained ankles, while ICD-10 has 72.

The U.S. version of ICD-10 also is far more complex than the code sets used in other nations, according to the association. The U.S. version, for instance, has 68,000 diagnosis codes compared with 30,000 for Canada and 16,013 for Australia; and 87,000 procedure codes, compared with 18,000 for Canada and 6,055 for Australia, according to the association.

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