Psychiatric News November 7, 2003
Volume 38 Number 21
© 2003 American Psychiatric Association
p. 4
Coding Help Available to Psychiatrists During HIPAA Transition Period
The new HIPAA Transactions Rule required health insurers, hospitals, physicians, and claims administrators to use a uniform electronic billing system by October 16. However, the Centers for Medicare and Medicaid Services (CMS) made two important announcements in September:
• Although the administrative simplification portion of HIPAA stipulates the use of ICD-9-CM diagnostic codes in all electronic transactions, CMS has reassured psychiatrists and others that they can continue to use the diagnostic criteria found in DSM-IV to formulate diagnoses. Each of the diagnoses found in DSM-IV has been "crosswalked" to the appropriate ICD-9-CM code. Continued use of the DSM-IV codes for other purposes (for example, medical records, quality assessment, patient communications) is acceptable.
• The agency continues to accept and process health care claims that are not HIPAA compliant even though the October 16 deadline has passed. No new deadline was set when CMS made the announcement on September 23, but CMS officials said they will "regularly reassess the readiness" of providers to determine when providers must come into full compliance.
It is important to note that practices that do not do any electronic transactions are not covered under HIPAA. Medicare physicians who have small practices (defined as having fewer than 10 full-time employees) have been permitted to continue filing paper claims and, if they do this, are not bound by HIPAA regulations. If, however, a practice does any electronic transactions or has anyone else do them on their behalf (for example, a billing company), it is covered by HIPAA.
In addition, CMS announced last month that it will accept from covered entities only those Medicare claims that are electronically submitted unless there are unusual circumstances beyond the provider’s control, such as disruption in electronic service.
"You may experience occasional problems in submitting electronic claims during this transition phase," said Becky Yowell, assistant director of the Office of Healthcare Systems and Financing. If this happens, call APA’s Office of Healthcare Systems and Financing’s Help Line at (800) 343-4671. 
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