Page 25 - FPGEE Management Q&A Book

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adoption of new healthcare code sets for use in 12. (b) The Poison Prevention Packaging Act is
electronic health care transactions. This rule adopts generally enforced by the CPSC (Consumer Product
updated versions of the code sets, under the Safety Commission).
authority of HIPAA (ICD-10 final rule). The ICD-10
code sets replace the current ICD-9-CM code set. The FDA is known as the Food and Drug
Administration.
ICD-10 codes must be used on all HIPAA
transactions, including outpatient claims with dates The DEA is known as the Drug Enforcement
of service, and inpatient claims with dates of Administration, which regulates the Federal
discharge on and after October 1, 2013. Otherwise, controlled substance act.
claims and other transactions will be rejected, and
will need to be resubmitted. The FTC is known as the Federal Trade Commission;
it generally regulates unfair business practice and
ANSI X12 version 4010 is the current HIPAA antitrust violations.
electronic transaction standard. However, version
4010 is not capable of handling ICD-10 Procedure 13.(c) The approval of new packaging and labeling
and Diagnosis Codes. By Federal mandate, ANSI X12 of already marketed drugs should be done by filling
version 5010 will be the HIPAA electronic out a Supplement New Drug Application (SNDA).
transaction standard as of January 1, 2012. Version
5010 includes support for ICD-10 diagnosis and An SNDA can be used for:
procedure codes.
1. Change in labeling and packaging of already
Today, the industry uses about 13,500 unique ICD- marketed drugs.
9-CM volume 1 & 2 codes to describe diagnosis.
ICD-9 diagnosis codes are 3-5 digits in length (e.g., 2. Change in manufacturing location.
821.01 – Closed Fracture of shaft of femur). With
the ICD-10-CM mandate, the length of diagnosis 3. Any change in synthesis of drugs.
codes will increase to 3-6 alphanumeric characters
plus a qualifier (e.g., S72.344 – Displaced spiral 4. Change in production procedure of drugs.
fracture of shaft of right femur). There will be about
69,000 codes with a much greater level of 14.(d) There are hundreds of health-related quality
specificity. of life instruments available. There are mainly
divided into following two categories:
The industry currently uses about 4,000 unique ICD-
9-CM volume 3 codes to describe inpatient 1. Disease-specific instruments
procedures. ICD-9 procedure codes are 3-4 digits in 2. Generic/general instruments
length (e.g., 47.01 – Laparoscopic appendectomy).
With the ICD-10-PCS mandate, the length of 1. Disease Specific Instruments: They provide
inpatient procedure codes will increase to 7 detailed information in terms of functioning and
alphanumeric characters (e.g., ODTJ4ZZ – well-being that may be associated with a particular
Laparoscopic appendectomy). There will be about disease. They are classified into the following
72,000 unique codes with much greater detail than categories:
the current procedure codes.
1. Disease specific (e.g. hypertension, diabetes)
11. (c) Mr. Shah’s response is an example of a 2. Population specific (e.g. elderly, infant)
quizzing response. 3. Function specific (e.g. sexual functioning)
4. Condition or problem specific (e.g. pain)

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