Updated on: March 16, 2016

CMS Issues Reminder Regarding 5010, ICD-10 Implementation

Original story posted on: July 21, 2011

WASHINGTON, D.C. – The Centers for Medicare & Medicaid Services (CMS) is starting to issue gentle reminders to states regarding the upcoming conversion to the 5010 electronic data interchange standards and implementation of ICD-10 coding.

A CMS memo released Wednesday cited the conversion timelines for each initiative and reminded states about the availability of federal resources to help them through the respective transitions.

The final regulation governing the transition to ICD-10 was issued by the U.S. Department of Health and Human Services on Jan. 16, 2009, requiring all “covered entities” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to adopt ICD-10 codes for use in all HIPAA transactions related to services provided on and after the Oct. 1, 2013 compliance date.

Prior to processing ICD-10 claims, states first must implement the Version 5010 transaction standards required by HIPAA, as the existing 4010/4010A1 standards do not support the use of ICD-10 codes, CMS noted in its memo. States must install Version 5010 and test it with all vendors and trading partners by Jan. 1, 2012.

Coordination between the Version 5010 and ICD-10 implementations is necessary to identify impacted transactions and systems, CMS indicated. Federal officials are warning that if states are not prepared to accept 5010 claims by the compliance date, they may experience large increases in provider customer service inquiries, thus affecting their operations. In addition, CMS noted, this could cause financial hardships for providers since it would increase the likelihood of delayed payments. (For more information on Version 5010, go to the CMS website at https://www.cms.gov/ICD10 and click on the “Version 5010” link on the left side of the page.)

The CMS memo described the pending conversion from ICD-9 to ICD-10 as a “significant change” for states and, unlike previous HIPAA initiatives, a switch expected to impact Medicaid providers and processes as much as the technology systems themselves. “ICD-10 implementation is much more than a code set update, as diagnosis and inpatient procedure codes are a large part of the foundation of policy and processes in Medicaid operations,” the memo noted.

Implementing ICD-10 will require states to redefine their policies to align with the new code set, officials noted – for example, states will need to update how they determine both coverage and payment for products and services. Since ICD codes are used in almost every clinical and administrative process and system, implementation is expected to impact nearly every aspect of states’ Medicaid operations.

The CMS memo indicated that the agency “understands the magnitude of work involved in implementing ICD-10 and is offering a variety of technical assistance resources” to states. An example is the recent development of the ICD-10 Implementation Assistance Navigation Tool, a resource intended to help states understand and implement ICD-10 (the tool can be found at https://medicaidicd10.noblis.org/.) There are two types of assistance material on the site, CMS noted: the Medicaid ICD-10 Implementation Assistance Handbook and the training modules presented at the Regional Office ICD-10 Training Workshops.

States already should be preparing for ICD-10 implementation, CMS noted, with each state already expected to have completed the assessment phase, which includes planning activities, performing impact analyses, developing remediation strategies and establishing internal and federal funding levels. Officials said states currently should be entering the remediation phase, which includes developing requirements; implementing policy, process, and system updates; and executing system testing.

Upcoming assistance also will come in the form of site visits to many states during the next three months, CMS noted. States with additional questions or comments about ICD-10 or the technical assistance provided by federal oversight authorities are being welcomed to e-mail them to .



Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years.