ICD-10/5010 and HIPAA Compliance

As a DC, you may be hearing a lot about new ICD-10 and 5010 industry standards. We want to ensure that as your software vendor, we keep you and your practice updated and informed on everything your business could need; be it support for a stimulus rebate, HIPAA compliance, or simply new enhancements that take one more time-consuming task off your plate.

Let's take some time to explore what the ICD-10 and 5010 standards mean to you and your practice, and what new developments are rising on the healthcare horizon.

ICD-10 and 5010 Defined

  • ICD-10 is the new version of diagnostic coding which will be required come 2013.
  • 5010 is the EDI standard for HIPAA transactions used to submit Medicare claims.

Implementation Timeline

Go-Live Date Compliance Step
January 1, 2010
Payers and providers - begin internal testing of Version 5010 standards for electronic claims
December 31, 2010
Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance
January 1, 2011
Payers and providers should begin external testing of Version 5010 for electronic claims *CMS begins accepting Version 5010 claims *Version 4010 claims continue to be accepted
December 31, 2011
External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance
January 1, 2012
*All electronic claims must use Version 5010 *Version 4010 claims are no longer accepted
October 1, 2013
* Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures * CPT codes will continue to be used for outpatient services


What if I don't submit to Medicare?

Everyone covered by HIPAA must transition to 5010 standards, whether or not the bill Medicare.

What is the deadline for my vendor to support ICD-10 and 5010 standards?

Software vendors should have developed their product to fully comply with 5010 standards by January 2012, and ICD-10 by October 2013.

What if I only submit paper claims?

Electronic claim submission is not mandatory in 2012, but encouraged. DCs can still file paper claims, but check with your payers to examine their individual requirements.

Will my paper claims change because of the new 5010 standard?

The 1500 paper claims will not change. They already accommodate the relevant 5010 data.

Which codes are affected by the ICD-10 transition?

ICD-10 codes replace ICD-9 codes for reporting diagnoses only. they will have no effect on the CPT codes used to report procedures or services.

Where is ChiroTouch in the process of meeting these standards?

We are currently in the process of implementing the features necessary to support you as you reach these compliance goals.

Where can I find more information? - The Centers for Medicare and Medicaid Services is currently the leading source of information about ICD-10 and 5010.