Not sure how many of you are following the current federal legislative
activities related to adopting ICD-10-CM and ICD-10-PCS as replacements
for their counterpart ICD-9 code sets for coding diagnoses and
procedures. Briefly, there are currently two bills in process:
House of Representatives: HR 4157
Senate: S 1952.
As always, the full text of each of these bills can be found by
searching at http://thomas.loc.gov/ . Applicable portions of each as
recently drafted, courtesy of a colleague, are appended below.

Contact me if you'd like to learn what these bills will likely mean
regarding adopting ICD-10-CM, ICD-10-PCS, and X12 version 005010 Type 3
Technical Reports (TR3's) for HIPAA.

Dave Feinberg
Rensis Corporation [A Consulting Company]
206-617-1717
DAFeinberg@...
Author of "Understanding HIPAA Communications"

_ _ _

Draft Language in HR 4157 related to ICD-10 as of Thanksgiving 2005

SEC. 5. RULEMAKING TO UPGRADE ASC X12 AND NCPDP STANDARDS AND ICD CODES.
(a) In General- Not later than April 1, 2007, the Secretary of Health
and Human Services shall promulgate a final rule under section 1174(b)
of the Social Security Act (42 U.S.C. 1320d-3(b)) to provide for the
following modification of standards:

(1) ACCREDITED STANDARDS COMMITTEE X12 (ASC X12) STANDARD-
The replacement of the Accredited Standards Committee X12 (ASC X12)
version 4010 adopted under section 1173(a) of such Act (42 U.S.C.
1320d-2(a)), including for purposes of part A of title XVIII of such
Act, with the ASC X12 version 5010, as reviewed by the National
Committee on Vital Health Statistics.

(2) NATIONAL COUNCIL FOR PRESCRIPTION DRUG
PROGRAMS (NCPDP) TELECOMMUNICATIONS STANDARDS-
The replacement of the National Council for Prescription Drug Programs
(NCPDP) Telecommunications Standards version 5.1 adopted under section
1173(a) of such Act (42 U.S.C. 1320d-2(a)), including for purposes of
part A of title XVIII of such Act, with NCPDP Telecommunications
Standards version C.3, as approved by such Council and reviewed by the
National Committee on Vital Health Statistics.

(3) ICD CODES- The replacement of the International Statistical
Classification of Diseases and Related Health Problems, 9th revision,
Clinical Modification (ICD-9-CM) under the regulation promulgated under
section 1173(c) of such Act (42 U.S.C. 1320d-2(c)), including for
purposes of part A of title XVIII of such Act, with both of the
following:

(A) The International Statistical Classification of Diseases and
Related Health Problems, 10th revision, Clinical Modification
(ICD-10-CM).

(B) The International Statistical Classification of Diseases and
Related Health Problems, 10th revision, Procedure Coding System
(ICD-10-PCS).

(b) Rule of Construction- Nothing in subsection (a)(3) shall be
construed as affecting the application of classification methodologies
or codes, such as CPT or HCPCS codes, other than under the International
Statistical Classification of Diseases and Related Health Problems
(ICD).

(c) Notice- Not later than 30 days after the date of the enactment of
this Act, the Secretary of Health and Human Services shall publish in
the Federal Register a notice of the requirements to promulgate final
rules under subsection (a). Such notice shall include--

(1) the respective date by which each such rule must be promulgated
under such subsection;

(2) the respective compliance date described in subsection (e) for
each such rule; and

(3) a statement that entities covered under the Health Insurance
Portability and Accountability Act of 1996 and health information
technology vendors should plan for the implementation of upgraded ASC
X12, NCPDP, and ICD codes under such subsection.

(d) No Judicial Review- The final rules promulgated under subsections
(a) shall not be subject to judicial review.

(e) Compliance With Upgraded Standards- For purposes of section
1175(b)(2) of the Social Security Act (42 U.S.C. 1320d-4(b)(2))--

(1) ASC X12 AND NCPDP STANDARDS- The final rules promulgated under
paragraphs (1) and (2) of subsection (a) shall apply to transactions
occurring on or after April 1, 2009.

(2) ICD CODES- The final rule promulgated under paragraph (3) of
subsection (a) shall apply to transactions occurring on or after October
1, 2009.
_ _ _

Draft Language in S 1952 related to ICD-10 as of Thanksgiving 2005

SEC. 3. REPLACEMENT OF THE INTERNATIONAL STATISTICAL
CLASSIFICATION OF DISEASES.
(a) In General- Not later than October 1, 2006, the Secretary of Health
and Human Services shall promulgate a final rule concerning the
replacement of the International Statistical Classification of Diseases,
9th revision, Clinical Modification (referred to in this section as the
`ICD-9-CM'), under the regulation promulgated under section 1173(c) of
the Social Security Act (42 U.S.C. 1320d-2(c)), including for purposes
of part A of title XVIII, or part B where appropriate, of such Act, with
the use of each of the following:

(1) The International Statistical Classification of Diseases and
Related Health Problems, 10th revision, Clinical Modification (referred
to in this section as `ICD-10-CM').

(2) The International Statistical Classification of Diseases and
Related Health Problems, 10th revision, Clinical Modification Coding
System (referred to in this section as `ICD-10-PCS').

(b) Implementation-

(1) IN GENERAL- The Secretary of Health and Human Services shall
ensure that the rule promulgated under subsection (a) is implemented by
not later than October 1, 2009. In carrying out the preceding sentence,
the Secretary shall ensure that such rule ensure that Accredited
Standards Committee X12 HIPAA transactions version (v) 4010 is upgraded
to a newer version 5010, and that the National Council for Prescription
Drug Programs Telecommunications Standards version 5.1 is updated to a
newer version (to be released by the named by the National Council for
Prescription Drug Programs Telecommunications Standards) that
supersedes, in part, existing legislation and regulations under the
Health Insurance Portability and Accountability Act of 1996.

(2) AUTHORITY- The Secretary of Health and Human Services shall have
the authority to adopt, without notice and comment rulemaking, standards
for electronic health care transactions under section 1173 of the Social
Security Act (42 U.S.C. 1320d-2) that are recommended to the Secretary
by the Accredited Standards Committee X12 of the American National
Standards Institute in relation to the replacement of ICD-9-CM with
ICD-10-CM and ICD-10-PCS. Such modifications shall be published in the
Federal Register.

(c) Notice of Intent- Not later than 30 days after the date of enactment
of this Act, the Secretary of Health and Human Services shall issue and
publish in the Federal Register a Notice of Intent that--

(1) adoption of Accredited Standards Committee X12 HIPAA
transactions version (v) 5010 shall occur not later than April 1, 2007,
and compliance with such rule shall apply to transactions occurring on
or after April 1, 2009;

(2) adoption of the National Council for Prescription Drug Programs
Telecommunications Standards version 5.1 with a new version will occur
not later than April 1, 2007, and compliance with such rule shall apply
to transactions occurring on or after April 1, 2009;

(3) adoption of ICD-10-CM and ICD-10-PCS will occur not later than
October 1, 2006, and compliance with such rules shall apply to
transactions occurring on or after October 1, 2009; and

(4) covered entities and health technology vendors under the Health
Insurance Potability and Accountability Act of 1996 shall begin the
process of planning for and implementing the updating of the new
versions and editions referred to in this subsection.

(d) Assurances of Code Availability- The Secretary of Health and Human
Services shall take such action as may be necessary to ensure that
procedure codes are promptly available for assignment and use under
ICD-9-CM until such time as ICD-9-CM is replaced as a code set standard
under section 1173(c) of the Social Security Act with ICD-10-PCS.

(e) Deadline- Notwithstanding section 1172(f) of the Social Security Act
(42 U.S.C. 1320d-1(f)), the Secretary of Health and Human Services shall
adopt the modifications provided for in this section without a
recommendation of the National Committee on Vital and Health Statistics
unless such recommendation is made to the Secretary on or before a date
specified by the Secretary as consistent with the implementation of the
replacement of ICD-9-CM with ICD-10-CM and ICD-10-PCS for transactions
occurring on or after October 1, 2009.

(f) Limitation on Judicial Review- The rule promulgated under subsection
(a) shall not be subject to judicial review.

(g) Application- The rule promulgated under subsection (a) shall apply
to transactions occurring on or after October 1, 2009.

(h) Rule of Construction- Nothing in this section shall be construed as
effecting the application of classification methodologies or codes, such
as the Current Procedural Terminology (CPT) as maintained and
distributed by the American Medical Association and the Healthcare
Common Procedure Coding System (HCPCS) as maintained and distributed by
the Department of Health and Human Services, other than under the
International Statistical Classification of Disease and Related Health
Problems.

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