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Back  RFI # 1168: Combination maps for ICD-10

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Submitter

Suman de

Description

This question is specific to the 837I, but applies to all claims, the 270/271 and 278. An ICD-10 code can be a combination type of map, i.e ICD-9= ICD-10 code1 + ICD-10 code2 based on the scenario choicelists type as provided by the CMS General Equivalence Map. In such a case will there be 2 codes that could be assigned as a comma seperated value in the HI-01 of a 5010 file (837/270/271/278).

How will the HI segment handle ICD-9 to ICD-10 conversion codes which will be two or more codes in cases of combination representation?

Response

There are several items in this request, some of which are regarding codes sets adopted for use under HIPAA which cannot be addressed by ASC X12. See the Recommend section.

The compliant method for sending either ICD-9-CM or ICD-10-CM codes in the HI segment requires the use of one composite data element (C022) for each code. The first data element in the composite must contain a valid code qualifier from the ASC X12N TR3. In the 837 transactions for the Principal Diagnosis use code qualifier BK for ICD-9-CM codes in HI01-1 or use code qualifier ABK for ICD-10-CM codes HI01-1. The second data element in the composite must contain the corresponding diagnosis code (e.g. HI01-2 for Principal Diagnosis). Only one diagnosis code is to be sent in each element.

When submitting a transaction (e.g. 837, 270 or 278) for dates of service that are mandated by HIPAA to be ICD-10-CM, the HI segment will carry a single ICD-10-CM code in each composite data element, the same as ICD-9-CM is used today.

Recommendation

We recommend reviewing the code set Final Rules for information on the use of the ICD code sets and the applicable coding guidelines that accompany the code sets.
Submission 10/5/2010
Status Date 1/3/2011
Status F - Final
Primary References
Document 005010X223
SectionClaim
Page68
Set IDHI
Loop2300
Segment Position2310
Segment IDHI
Element Position01
Component Position02
External Code ListABK
Code ValueICD-10 cod