ICD-10 Information

ICD-10 Coding Information

Starting October 1, 2015, the health care industry’s payers, providers, vendors, and all Health Insurance Portability and Accountability Act (HIPAA) covered entities will be required to use the International Classification of Disease 10th Edition (ICD-10) diagnosis codes (CM) and inpatient procedure code sets (PCS). The International Classification of Disease, 10th Edition, Clinical Modification/Procedure Coding System is a diagnosis coding system for diseases and signs, symptoms, abnormal findings, complaints, social circumstances, and external cause of injury or disease and a procedure coding system for inpatient procedures. The 10th edition of these code sets replaces the ICD-9 code sets that have been in use in the United States since 1979. ICD-10 consists of two parts:

  1. ICD-10 CM for diagnosis codes:
  • For use in all health care settings
  • Diagnosis coding under ICD-10 uses 3 to 7 alphanumeric digits instead of the 3 to 5 digits used with ICD-9
  1. ICD-10 PCS for inpatient procedure coding:
  • For use in inpatient hospital settings
  • Coding under ICD-10 uses 7 alphanumeric digits instead of 3 to 4 digits used with ICD-9

The key differences between ICD-9 and ICD-10 include the following:

  • Significantly greater volume of codes
  • Significantly greater specificity in code descriptions
  • Addition of alphanumeric characters

Note: Medicaid does not conduct coding training.

Important Billing Information

ICD-10 implementation is Date of Service specific:

  1. ICD-9 diagnosis and surgical procedure codes will be required on claims that contain Dates of Service (DOS) or Dates of discharge (DOD) of September 30, 2015 and before.
  2. ICD-10 diagnosis and surgical procedure codes are required on claims that contain DOS or DOD of October 1, 2015 or after.
  3. Claims submitted with both ICD-9 and ICD-10 codes will reject. Providers will have to submit two different claims based on the DOS or DOD.

DSM 5 Information

While ICD-10 and DSM-5 are complimentary since DSM-5 uses the ICD-10 coding standards and ICD-9 and DSM-IV are similarly complementary, neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and therefore may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnosis decisions on the DSM-IV/DSM-5 criteria, and if so, to crosswalk those decisions to the appropriate ICD-9-CM and as of 10/1/15 (dates of service), ICD-10-CM codes.

Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, www.dsm5.org.

ICD-10 News & Updates

ICD-10 Coding Information

ICD-10 Monitor

ICD-10 Watch

ICD-10 Survey Closed

  • The Department recently surveyed the Medicaid provider community to assess general readiness for the ICD Transition

  • Survey Results

SMA ICD-10 Provider Readiness Assessment

  • Survey results closed on December 31, 2013

  • Results are currently being reviewed by CMS

  • National and individual states’ data summaries should be available mid-March

 

General ICD-10 Resources

Provider Resources

There is a wealth of ICD-10 resources available to help prepare for the transition from ICD-9. Providers should contact Emdeon, Edifecs, or Optum for testing information.

Coding-Specific Resources

Additional Coding Initiatives

National Correct Coding Initiative (NCCI)

  • Implemented April 1, 2013

  • Prevents payment errors due to improper coding

  • Applies only to inpatient and outpatient procedure codes, except for APR-DRG codes

All Patient Refined-Diagnosis Related Group (APR-DRG)

  • Expands basic DRG structure

  • Adds severity of illness, risk of mortality factors and is intended for all patient populations

  • Will be implemented with ICD-9 codes and updated to include ICD-10

Approved Vendor List

The Colorado Medicaid Approved Vendor List includes vendors that have completed ICD-10 end-to-end testing with payors and are now ICD-10 compliant. If you or your organization would like to submit claims to Colorado Medicaid but are unable to submit ICD-10 compliant claims, please contact one of the vendors from this list. 

Company Name

Contact Name

Contact Number

Healthfusion

Patti Brinkmeyer

877-523-2120

Physician’s Computer Company

Justin Ballou

802-846-8177

Cortex EDI, Inc

Ani

800-485-5977

Clinix MIS

Karen Brown

270-441-7337 (ext. 222)

Axiom Systems Inc

Gigi Maniago

602-439-2525

Sava Senior Care Administrative Services, LLC

Kathy Hurst

832-467-5541

Therap Services, LLC

James Kelly

203-596-7553

Victory Billing

Vickie Hannis

731-426-4343

Insurance Data Services

Tami Michelfelder

616-532-800 (ext. 142)

NTT Data Long Term Care Solutions, Inc.

Cindy Hartman

877-393-6965

IDX Systems Corporation/GE Healthcare

Christina Davis

802-859-6940

EDI Edits & Documentation Group Quadax, Inc.

EDI Sales Staff

440-777-6300

PHIcure, Inc.

Wayne Koch

518-507-5899 or 888-501-6266

Laboratory Corporation of America

Linda lockhart

336-436-5806

eProvider Solutions

Val Vant Hul

605-323-0800

Procura

Kathy Karlsen

877-776-2872 (ext. 6424)

NTT Data LTC Solutions, Inc.

Jim Ingalls

425-307-2260 or 800-426-2680