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Blue Cross of Northeastern Pennsylvania is planning for implementation of the HIPAA 5010 and ICD-10 regulations. You should be aware of these regulations and the impact they will have on claims submissions and electronic transactions with payers. We will continuously update you on our implementation plans as well as impacts, changes, and timeframes essential for compliance with both HIPAA 5010 and ICD-10.

ICD-10 Overview

Centers for Medicare & Medicaid Services (CMS) Federal rule requires that ICD-10 diagnosis & procedure codes replace ICD-9 codes for services starting October 1, 2015. Highlights of the ICD-10 regulation include:

  • Number of diagnosis codes increases from 13,000 to 68,000; size increases to up to 7 alpha numeric characters. (ICD-10 diagnosis codes apply to professional & institutional claims.)
  • Number of procedure codes increases from 3,000 to 87,000; size increases to 7 alpha numeric characters. (ICD-10 procedure codes used for institutional claims only.)
  • HCPCS/CPT procedure codes are not impacted.

We will continue to provide regular updates via our Provider Bulletin newsletter and our Provider Center website on the status of HIPAA 5010 and ICD-10 implementation. Please check back for further updates on implementation timelines, testing plans, and general provider updates. In addition, please work with your vendor/clearinghouse and share all pertinent 5010 and ICD-10 information accordingly.

CMS ICD-10 Resources

* BCNEPA will be following these guidelines with one exception: anywhere that it states a claim will be “returned as unprocessable” does not apply to BCNEPA and rather, the claim will be rejected.

PA Blues ICD-10 Provider Education Collaborative Monthly Presentations

Next "What's Up Wednesday" Call
Date: August 19, 2015
Time: 2pm – 3pm
Phone Number: 1-800-882-3610
Pass Code: 5411307

What's Up Wednesday Archive

ICD-10 End-to-End Testing

Provider Bulletin ICD-10 Articles