HIPAA Code Sets
The Federal HIPAA regulations issued by DHHS dictate that only approved code sets may be used in standard electronic transactions. The CMS site has official resources that define these standard code sets. The ICD-10 code sets are used to report medical diagnoses and inpatient procedures. The ICD-10 code sets were implemented effective October 1, 2015.
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts:
1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
Frequently Asked Questions
Please select the following link (SWH ICD Conversion FAQ) to review frequently asked questions related to Senior Whole Health of New York’s ICD-10 implementation.
ICD-10 Quick Reference Guide for LTSS Providers
Please select the following link (ICD-10 Quick Reference Guide for LTSS Providers) to access Senior Whole Health of New York’s quick reference guide for LTSS authorization requests and claims submissions.