Impact of HIPAA 5010 and ICD-10 Data Conversions

Today’s guest post is from Tony Lavinio, the principle software architect behind Progress DataDirect’s XML Converters and an expert on data exchange. Understanding the integration and data compliance pains experienced by healthcare organizations, Tony and DataDirect have developed a HIPAA toolkit to help Healthcare IT developers alleviate some of the challenges they’re facing with HIPAA 4010 and 5010 and ICD-10 projects.

The government has allocated healthcare providers over $36 billion of ARRA stimulus money to help the adoption of Electronic Health Records (EHRs) and in support of Health Information Exchanges (HIEs). Healthcare providers that coordinate EHR clinical information with administrative data will streamline their health records administration. Those organizations that implement a single, unified IT infrastructure to handle both EHR and administrative data will gain a significant cost saving and, ultimately, improve the quality of patient care.

However, to unify IT infrastructure healthcare providers face the estimated $14 billion challenge of complying with new coding standards. These standards set forth by the United States Department of Health and Human Services on Jan. 15, 2009 specify that X12 Electronic Data Interchange (EDI) transaction definitions for version 5010 – used in conjunction with HIPAA transactions, which are exclusively administrative data transactions – must be completed by January 2013. The new standards also require healthcare providers to comply with an International Classification of Diseases (ICD) standard update, from ICD-9 to ICD-10 by October 2013. The close relationship between HIPAA transaction sets that can directly refer to ICD-9 or ICD-10 codes have health industry IT professionals on the ropes.

The HIPAA 4010 to 5010 upgrade is a positive evolutionary change, improving the efficiency of healthcare data transactions. The ICD-9 to ICD-10 change is much more radical. ICD-9 list was first developed over 30 years ago and over that time has become deeply embedded into systems. Making the ICD-9 to ICD-10 transitions even more difficult is that the list for ICD-10 code updates is approximately 10× the length as ICD-9, with generally no 1:1 mappings between them. Sometimes there are a series of codes, sometimes there are alternatives that will take external information, and sometimes there are no direct alternatives. Healthcare IT professionals must figure out a way to accommodate changes in data when it has been moved, and overcome the fact that new data must be extracted from new sources to augment the legacy data.

With so much data to convert, Healthcare IT professionals struggle to find a logical starting place. Progress DataDirect has given Healthcare IT professionals a way to jump-start their EDI transaction definitions version 5010 and ICD-9 to ICD-10 data conversion projects with the company’s HIPAA/ICD Upgrade Toolkit.  Though each healthcare application is different and will need tweaking, using the examples provided in the Toolkit will make it far easier than starting from scratch. Some of what you’ll find in the starter-kit includes:

  • XQuery source for upgrading each of the 10 transaction sets from the HIPAA 4010 to equivalent 5010 version
  • 50 sample 4010 files to use with the above
  • ICD-9 to ICD-10 maps
  • A sample tool to compare the changes between ICD-9 codes and their closest ICD-10 analogs with HTML output
  • An XQuery program which will read a HIPAA file containing ICD-9 codes and report on any potential conversion troubles with ICD-10
  • An XQuery program to read a HIPAA EDI file and covert it from 4010 to 5010 and from ICD-9 to ICD-10  simultaneously

How it works is DataDirect XML Converters make EDI behave like XML. Then a small XQuery program, which is really good at rearranging XML, is able to transform thousands of EDI and flat-file formats to XML and back with little or no development time or expense or major re-architecting. For more information on transforming data in HIPAA 4010 X12 files and translating ICD-9 codes visit DataDirect’s Blog.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Thanks Tony Lavinio for such a detailed post on impact of HIPAA 5010 and ICD 10 i would like to suggest that Edifecs is a leader in HIPAA 5010 and Healthcare Channel Modernization solutions which provides healthcare software and solutions that automate exchange of information between health plans, hospitals, and other healthcare organizations.

Click here to post a comment