The procedure and diagnosis codes that are used on claims evolve over time as
new codes are added and existing codes are redefined or deleted. The buttons on
these pages provide access to the website articles that have been posted about
about code updates.
The annual Healthcare Common Procedure Coding System (HCPCS) additions,
changes, and deletions are effective for dates of service on or after January 1
each year. Smaller HCPCS updates are implemented quarterly throughout the year.
The annual International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) additions, revisions, and deletions are
effective for dates of service on or after October 1 each year.
The U.S. Department of Health and Human Services has published the final
regulation on International Classification of Diseases, Tenth Revision,
Clinical Modification (ICD-10-CM). The ICD-10-CM and ICD-10-PCS (inpatient
procedure code) code sets will replace ICD-9-CM codes that are used to report
medical diagnoses and inpatient procedures through Health Insurance Portability
and Accountability Act (HIPAA) standard transactions. Previously, the Centers
for Medicare & Medicaid Services (CMS) proposed that the effective date for
ICD-10 code sets would be October 1, 2013. CMS has now proposed changing this
date to October 1, 2015.
Texas state health-care programs must transition medical diagnosis and
inpatient procedure coding from ICD-9-CM to the ICD-10 code sets. The transition
to ICD-10 code sets will require business and system changes throughout the
health-care industry. All providers that are covered by HIPAA must make the
transition by the compliance date.
The ICD-10 Implementation web page has been created as a place to aggregate
information that will help providers make this significant transition. More
links and resources will be added, so providers and their claims-filing services
and software vendors are encouraged to check this page at least once a month.
The Patient Protection and Affordable Care
Act (PPACA) mandates that all claims submitted on or after October 1, 2010, must
be filed in accordance with the National Correct Coding Initiative (NCCI)
guidelines. NCCI was developed by the Centers for Medicare & Medicaid Services
(CMS) to promote the correct coding of health-care services by providers. NCCI
consists of pairs of procedure codes that should not be reported together.