ICD-10 Compliance Date Delayed Until 2015

Members | April 14, 2011

Oct. 1, 2015, is the new ICD-10 compliance date for providers, according to a  issued July 31 by the U.S. Department of Health and Human Services (HHS). 

The transition deadline for the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes system has been delayed until Oct. 1, 2015, according to a final rule issued July 31 by the U.S. Department of Health and Human Services (HHS). 

HHS said it believes the change in the compliance date for ICD-10 will allow providers more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.

The new rule extends by 1 year the Oct. 1, 2014, compliance deadline announced in the 2012 final rule issued by Kathleen Sebelius, former-secretary of the HHS.

For those following ICD-10 implementation, this final rule comes as no surprise. Section 212 in the Protecting Access to Medicare Act of 2014, which was signed into law earlier this year by the president, included the following language:

The secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.

Who is affected by the ICD-10 transition?

“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS) said in a press release. “For patients under the care of multiple providers, ICD-10 can help promote care coordination.” 

Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) is affected the ICD-10 transition. 

According to CMS, ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after Oct. 1, 2014. 

If providers do not use the new ICD-10 codes, claims and other transactions may be rejected, and the claims may need to be resubmitted with the ICD-10 codes. This could result in delays in reimbursement, so it is important to start now to prepare for the change over to ICD-10 codes. CMS provides important resources and the HIPAA 5010 and ICD implementation calendar dates.

On Jan. 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices that accommodates the ICD-10 codes. Because of that, the Version 5010 must be in place first before the change to ICD-10 to allow Version 5010 testing and implementation time.

If providers do not conduct electronic health transactions using Version 5010 as of Jan. 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations. Health care providers should prepare now for the Version 5010/ICD-10 transition.

You can now subscribe to the CMS ICD-10 e-mail updates

LeadingAge ICD-10 Educational Materials 

There are several basic steps that CMS is recommending in preparation for ICD-10 and Version 5010:  

HHS ICD-10 Announcements

  • July 31, 2014: HHS announces Oct. 1, 2015 ICD-10 compliance date.
  • Aug. 24, 2012: HHS announces final rule on ICD-10 delay.
  • April 9, 2012: HHS delays compliance date for ICD-10 from Oct. 1, 2013, to Oct. 1, 2014. The full release is online, and more information about this proposed rule can be found on the proposed rule ICD-10 fact sheet.
  • Version 5010 Enforcement Discretion Period: According to a March 15, 2012, announcement, the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) will not initiate enforcement action with respect to any HIPAA covered entity non-compliant with Version 5010 standards until after June 30, 2012. The compliance date for implementation of these updated standards remains Jan. 1, 2012. For more information, you can view the enforcement FAQs.
  • Feb 16, 2012: Health and Human Services (HHS) Sec. Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).  All HIPAA covered entities, including SNFs and HHAs, would be included in any delay  - the term “certain health care entities” is just a reference used from the original HIPAA regulatory language.

HHS/CMS ICD-10 Educational Conference Calls

CMS ICD-10 and Version 5010 Educational Materials

For more information on ICD-10 and Version 5010, visit CMS.