Compliance update on adoption of ICD-10 code sets

Delta Dental's compliance position regarding the Health Insurance Portability and Accountability Act (HIPAA), Adoption of ICD-10 Code Sets. Updated as of October 2016.
 

Summary of law

In January 2009, the U.S. Department of Health and Human Services (HHS) adopted the International Classification of Diseases, 10th Revision (ICD-10) code sets as the HIPAA standard to replace the ICD-9 Volumes 1 and 2 (diagnoses), and 3 (procedures). The ICD-10 rule requires the adoption of these code sets in applicable HIPAA covered transactions beginning on October 1, 2015. Each year CMS may release an updated set of codes to address changes and new developments.

In March 2016, CMS released its annual update for the 2017 ICD-10-CM and PCS codes for patient encounters occurring from October 1, 2016 through September 30, 2017.
 

What this means to Delta Dental

The ICD-10-CM codes are used for reporting diagnoses and ICD-10-PCS codes for reporting of inpatient hospital services and surgical procedures. Within the dental community, it is generally agreed dental care is only impacted by ICD-10-CM diagnosis codes. Since October 1, 2015, Delta Dental is able to receive these codes.

Although the ICD-10-CM code set is used in the U. S. for classifying diagnoses and reasons for visits in all health care settings including oral health and dental disease codes, the codes are primarily directed to medical care with very few capturing outpatient dental care. Even so, their use will be instrumental in the automated processing of enhanced benefit solutions, in the development of wellness programs and dental research.
 

Compliance position

Delta Dental adopted the ICD-10 code sets and completed testing of its systems and business processes as required. The enterprise has also updated its systems for the 2017 CMS ICD-10 code sets that became effective October 1, 2016.