ANSI Version 5010 / ICD-10

Covered entities* must comply with the standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. For Electronic Data Interchange (EDI) transactions, HIPAA requires use of the American National Standards Institute (ANSI) technical content and format specifications. HIPAA also requires use of the International Classification of Diseases (ICD) coding system for medical diagnoses and inpatient procedures.  

All electronic HIPAA-standard health care transactions must be transmitted in a format that complies with mandated changes to the current ANSI Version 4101A1 electronic data interchange (EDI) transaction set and ICD-9 code set. The rule establishes that all covered entities should begin testing and migrating to ANSI Version 5010 during the 2011 calendar year to lay the necessary groundwork prior to implementation of ICD-10. 

Compliance deadlines are as follows:

• Successful conversion to ANSI v5010 by Jan. 1, 2012 (Testing should already be underway)
• Migration to ICD-10 by Oct. 1, 2013 (Testing should begin as early as Oct. 1, 2012)

ANSI Version 5010 
Is your office ready for the transition? The ANSI Version 4010A1 EDI transaction sets are being upgraded to ANSI v5010, in accordance with HIPAA guidelines, and in preparation for the upcoming implementation of ICD-10. 

ICD-10 
The ICD-10 implementation will allow for greater specificity in defining diagnosis codes and procedure codes. Implementations in European countries have suggested that this will lead to improved health care services at lower costs with fewer errors and improved results.  

*By definition, HIPAA-covered entities affected by this rule include health plans, health care clearinghouses, information trading partners, health information networks, or health care providers who conduct HIPAA-standard transactions.