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ICD-10 Information

ICD-10 Information

Montana Medicaid is aware of the article "Medicaid ICD-10 Workarounds in California, Three Other States, Worry Providers," published in Modern Healthcare magazine. 

Please be advised that Montana Medicaid is ready to accept claims with ICD-10 codes on 10/1/2015! 

See below for additional ICD-10 information.


ICD-10 Final Rule

From the link: This final rule implements section 212 of the Protecting Access to Medicare Act of 2014 by changing the compliance date for the international Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2014 to October 1, 2015. It also requires the continued use of the International Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (procedures) (ICD-9-CM), including the Official ICD-9-CM Guidelines for Coding and Reporting, through September 30, 2015.


Announcements and Upcoming Events

CMS and AMA Announce Efforts to Help Providers Get Ready for ICD-10

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.  Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition

“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”

“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD.  “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to   physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.  The actions CMS is initiating today can help to mitigate potential problems.  We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms.

The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.

CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.

The AMA also has a broad range of materials available to help physicians prepare for the October 1 deadline.  To learn more and stay apprised on developments, visit AMA Wire.

CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:

  • Setting up an ICD-10 communications and coordination center.
  • Learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30.
  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27.

In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.


Free Webinar: How to Prepare for ICD-10 NOW

Presenter: Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
Prepare for ICD-10 with a successful, strategic implementation plan that encompasses your entire practice. If you’re not prepared for ICD-10 implementation, it’s not too late. In this 30-minute free webinar you will learn.

  • How to streamline your ICD-10 processes with proven strategies.
  • Key components of a successful ICD-10 implementation and strategies.
  • The impact of ICD-10 on each role within your office and how delegating to staff can ease the effort.
  • Examples of how ICD-10 will challenge your practice with practical solutions.
  • Strategic goals to help your office be successful on October 1, 2015.

BONUS Event registrants who complete the webinar will receive $500 worth of free ICD-10 resources, including ICD-10 Training Implementation Manual  and ICD-10 Crosswalks.

Testing and FAQs

Introduction

Are You Ready for ICD-10 Diagnosis Coding?

Have you ever seen someone who was struck by a turtle? With the new ICD-10 codes you will have a code specifically for being stuck by a turtle:


W59.22XA
Contact with turtles, struck by turtle, initial encounter

Image of a turtle

If you had provided services to someone who was struck by a turtle, under ICD-9 diagnosis coding, you would have billed:

E906.8
Other specified injury caused by animal

ICD-10 is much more detailed than the ICD-9 codes that are currently in use.

There is a lot of information available regarding ICD-10, and this webpage will be a great source of information to help you keep up on the conversion to ICD-10 for Montana Medicaid. Additional links are in the ICD-10 Informational Links panel below.

Encourage your health care professionals to begin documenting their services in more detail now! This will result in a smoother transition for the provider when ICD-10 is implemented on October 1, 2015.

Effective October 1, 2015, all providers will be required under HIPAA to use and bill ICD-10 format codes. For dates of service on or after October 1, 2015, claims submitted with an ICD-9 code will be denied.

This is based on the date of service billed, not the date of claim submission. When billing, providers will need to ensure they use ICD-9 codes for services provided on and before September 30, 2015, and ICD-10 codes for services on and after October 1, 2015.

ICD-10 Comparison

ITEM ICD-9-CM ICD-10-CM
Code Length 3–5 characters 3–7 characters
Number of Codes Approximately 14,000 codes Approximately 68,000 codes
Code Makeup Digit 1 = alpha or numeric
Digit 2-5 = numeric
Digit 1 = alpha
Digit 2 = numeric
Digit 3–7 = alpha or numeric
Expandability (space for new codes) Limited Flexible
Code Detail Vague Very specific
Code Examples E917.4
Striking against or struck accidentally by other stationary object without subsequent fall
W22.02XA
Walked into lamppost, initial encounter

 

ITEM ICD-9-CM ICD-10-CM-PCS
Code Length 3–4 characters 7 alphanumeric characters; all are required
Number of Codes Approximately 4,000 codes Approximately 72,000 codes
Expandability
(space for new codes)
Limited Flexible
Code Detail Limited detail More detail definitions on anatomy site, approach, device, and other information
Code Examples 741
Low Cervical C-Section
10D00Z1
Obstetrics, Pregnancy, Extraction, Products of Conception, Open Approach, No Device, Low Cervical

ICD-10 Informational Resources

ICD-10 Implementation Success Initiative

To help your ICD-10 implementation efforts, the American Association of Professional Coders (AAPC), the Workgroup for Electronic Data Interchange (WEDI), and the Centers for Medicare and Medicaid Services (CMS) have developed an ICD-10 Implementation Success Initiative.

This initiative is comprised of a searchable public database of ICD-10 issues for submission, help prioritizing those issues, and a series of educational webinars and articles available as a resource to highlight prominent ICD-10 conversion issues and trends.

The searchable database is easy to use. Once you submit your issue, it is reviewed, and once approved, it is made available online. If you provide your name and contact information, WEDI will also follow up with you directly.

Understanding how the new codes and coding standards impact diagnosis and inpatient procedures is imperative to the transition to ICD-10. We encourage you to use this resource for your organization!


Informational Links

Several associations are publishing information on ICD-10 coding. Below are links we believe you will find useful. Even though the implementation date in these resources may not reflect the current date of October 1, 2015, they are still useful resources. The Department of Public Health and Human Services does not promote any one organization/ association over another.

There are also guides to implementation of ICD-10 coding. The Centers for Medicare and Medicaid Services (CMS) has published information that is helpful to all provider types and payers.  

Additional information about ICD-10 is available on these websites.

If you need help converting ICD-9 and ICD-10 codes, there are free conversion tools to assist you. These tools are only to assist you in code selection, not to directly code for you. Some clinical analysis may be required to choose the most accurate code.

Provider Notices and Training

Provider Notices

11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
07.31.2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
06.24.2015 ICD-10 and Nursing Facility Requirements
06.12.2014 ICD-10 Delay
01.29.2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update
11.26.2013 ICD-10 Readiness

Training

ICD-10 Training 08.2015 and 09.2015
Presented by Jennifer Tucker, DPHHS; Tom Keith, Xerox; and Aaron Hahm, Xerox

Printable ICD-10 PDF You may type directly in this PDF and save to your hard drive, or print and write notes.
ICD-10 Nursing Facility 08.2015
Presented by Jennifer Tucker, DPHHS; Tom Keith, Xerox; and Aaron Hahm, Xerox
Printable ICD-10 PDF
Printable WINASAP 5010 PDF
ICD-10
This training was presented at the Spring 2015 Provider Training
ICD-10 ICD-10 is coming. Are you ready?
This training was presented at the Fall 2014 Provider Training.
ICD-10 Documentation and Coding Concepts
ICD-10 Readiness Courses
ICD-10: A Quick Course for Non-Coders
Presented by author/ICD-10 expert Gail I. Smith, MA, RHIA, CCS-P. Designed for healthcare professionals who are not coders but who will use and depend on the data from the new coding system.
ICD-10 Provider Training 2014
ICD-10 Basics MLN Connects Call 8/22/13 (1:19:35)
ICD-10 Implementation for Physicians, Partial Code Freeze, and MS-DRG Conversion (19:14)
Begin Transitioning to ICD-10 in 2013 (1:23:11)

Contact Information

For Questions regarding ICD-10 please contact your Medicaid Program Officer.