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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:
The key differences between ICD-9 and ICD-10 include the following:
Note: Medicaid does not conduct coding training.
ICD-10 implementation is Date of Service specific:
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 Survey Closed
The Department recently surveyed the Medicaid provider community to assess general readiness for the ICD Transition
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
The Department of Health Care Policy and Financing (the Department) is currently working with the fiscal agent, Xerox State Healthcare, to implement ICD-10 into the current Medicaid Management Information System (MMIS). 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 ICD-10 diagnosis (CM) and inpatient procedure code sets (PCS).
ICD-10 Phase Schedule Implementation Timeline
Communication & Awareness Plan
Supporting Vendor Evaluations
Internal Training Plan
Review Program Organization
Conduct Impact Analysis
Review Translation Options
Create ICD-10 Remediation Strategy & Plan
Code Mapping/Clinical Review
Level 1 Unit and System testing (internal)
Level 2 end to end testing (external)
October 1st 2015
October 1st 2015 - June 1st 2016
*Dates listed are tentative and may change through the progression of the Software Development Life Cycle
**Policy Remediation will be an ongoing and repetitive effort past the System Remediation implementation date
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.
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
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.
Physician’s Computer Company
Cortex EDI, Inc
270-441-7337 (ext. 222)
Axiom Systems Inc
Sava Senior Care Administrative Services, LLC
Therap Services, LLC
Insurance Data Services
616-532-800 (ext. 142)
NTT Data Long Term Care Solutions, Inc.
IDX Systems Corporation/GE Healthcare
EDI Edits & Documentation Group Quadax, Inc.
EDI Sales Staff
518-507-5899 or 888-501-6266
Laboratory Corporation of America
Val Vant Hul
877-776-2872 (ext. 6424)
NTT Data LTC Solutions, Inc.
425-307-2260 or 800-426-2680