WEDI, ASC X12 Release Guidance for Transactions that Require ICD-10 Codes

The Workgroup for Electronic Data Interchange and the ASC X12 subcommittee that creates and updates the HIPAA transaction sets have jointly developed guidance to help healthcare organizations better understand where to focus their ICD-10 testing to ensure that codes are correctly placed and formatted within the transactions.

The guidance offers information on the transactions affected by ICD-10, as well as the placement of the codes within the transactions. It also highlights the transactions and content that will need to be validated as part of the testing effort.

The guidance is also designed to help facilitate implementation and testing of ICD-10-CM and ICD-10-PCS to ensure the codes are accurately passed from providers to payers within the required HIPAA transactions to exchange diagnosis and procedure information.

Such testing can include verification that transaction and code formats are correct, the codes are valid or that the number of their occurrences are appropriate. The guidance also can be used as an input to an ICD-10 impact assessment and subsequent remediation planning.

“Although it can be argued that implementation of version 5010 of the ASC X12 transaction tested the format that will be used to carry ICD-10 codes, the industry did not focus on assuring that ICD-10 codes were correctly assigned and reflected on these transactions or that ICD-10 codes were correctly processed in front-end applications,” says Jim Daley, WEDI chairman. “This document will help highlight the transactions and content that will need to be validated as part of the ICD-10 testing effort.”

The guidance, which is titled “The ICD-10 Impact to HIPAA Transactions,” can be downloaded for free on the WEDI website, www.wedi.org.