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Washington Highlights

CMS Issues Two Final HIPAA Transaction and Code Set Rules

January 16, 2009—The Centers for Medicare and Medicaid Services (CMS) Jan. 16 issued two final rules related to HIPAA code sets. The rules are designed to facilitate the transition to an electronic health care environment. One rule revises standards for electronic transactions (such as health care claims and enrollment and disenrollment in a health plan) and the code sets to be used in those transactions. The rule requires covered entities to comply with Version 5010 on Jan. 1, 2012.

The second rule adopts ICD-10, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis and coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These code sets are used by providers that transmit any electronic health information in connection with a transaction for which the Department of Health and Human Services has adopted a standard. Compliance with the ICD-10 code sets rule begins Oct. 1, 2013.


Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806