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.

HCPCS

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.

ICD-9-CM

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.

ICD-10 Implementation

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, 2014.

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.

NCCI Compliance

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.