ICD-10

June 30, 2015

Webinars and Training

Implementation

Implementation from ICD-9 to ICD-10 will be Oct. 1, 2015.

MHCP will update providers through this page and through the Provider News as more details are available. MHCP does not complete ICD-10 related readiness surveys from business partners.

ICD-10 Codes

Providers and payers use ICD codes to classify, store and retrieve diagnostic or procedural information, manage electronic health records and process claims.

ICD-10 code sets will replace ICD-9 code sets. The Centers for Medicare & Medicaid Services (CMS) requires that all providers, payers, health plans, clearinghouses and vendors (all HIPAA-covered entities) begin using ICD-10-CM/PCS* on transactions for dates of service and inpatient discharges on and after October 1, 2015.

ICD-10 codes consist of two parts:

  • • ICD-10-CM: Diagnosis coding
  • • ICD-10-PCS: Procedure coding for inpatient hospital settings

  • Provider Impacts

    ICD-10 codes impact all providers in every health care setting.

    The ICD-10 implementation requires operational changes of the following for both providers and MHCP:

  • • Benefits and coverage (for example, authorization or assessment requests)
  • • Claim transactions
  • • Claim attachments
  • • Rate and payment determinations
  • • Medical review policies
  • • Plan structures:
  • • Health care homes (HCH)
  • • Waiver services
  • • Managed care organizations (MCO)
  • • Accountable care organizations (ACO)
  • • Business partner processes

  • ICD-10 is a code set change, not a file transmission or connection change.

    ICD-10 does not affect CPT, HCPCS or provider enrollment. Providers do not need to re-enroll for ICD-10. Continue to refer to the enrollment page for any enrollment changes.

    Mental health providers: also see ICD-10 Implementation information for mental health providers.

    ICD-9 to ICD-10 Comparison

    Code

    ICD-9-CM (current)

    ICD-10-CM/PCS (on and after 10/1/2015)

    Volume

    Diagnosis codes

    14,300

    Diagnosis codes

    69,000

    Procedure codes

    3,800

    Procedure codes

    72,000

    Composition

  • • Codes are mostly numeric
  • • Codes begin with numeric characters, except for E and V codes
  • • Valid codes are 3-5 characters
  • • Codes are all alphanumeric
  • • Codes begin with alpha characters
  • • Valid codes are 3-7 characters

  • ICD-10 Code Information

    Diagnostic criteria for coverage are in the covered services sections of the MHCP Provider Manual. ICD-10 codes must support a specific medical necessity. An exact one-to-one matching of the ICD-9 and ICD-10 codes is not possible due to the changes in structure and concepts in ICD-10. Coding is based on documentation in the medical record for each client. Providers must understand the intent of the code for the situation and use the diagnosis code that most accurately represents the patient’s condition.

    Information about ICD-10-CM, ICD-10-PCS (Procedure Coding System) code sets and the ICD-10-CM official guidelines are available on the CMS ICD-10 website.

    Crosswalks

    MHCP will not provide a crosswalk for converting ICD-9 to ICD-10 codes. Crosswalks or web searches on codes are not a substitute for understanding and fully implementing ICD-10. Providers may consult the CMS General Equivalence Mappings (GEMs) for help, but GEMs are not an exact crosswalk between the code sets. The GEMs are intended to serve as tools, but do not replace proper coding based on a patient’s condition.


    Provider Testing

    MHCP is offering a phased, end-to-end testing for the transition to ICD-10. The phases are as follows:

  • 1. Internal testing began in 2013 and will continue through implementation as needed.
  • 2. Pilot-group testing with a select group of partners and providers began June 1, 2015, and will continue through implementation.
  • 3. All MHCP enrolled providers are allowed to test, beginning July 6, 2015. We will post instructions for connecting with our MN–ITS testing environment on Monday, July 6, 2015.

  • Webinars and Training

    DHS will not be providing training on ICD-10 coding. Visit the following websites regularly for the latest news, resources, webinars and training:

  • CMS.gov ICD-10 – watch for the latest news and resources. Review the Provider Resources page for information on webinars and other news for providers.
  • Workgroup for Electronic Data Interchange (WEDI) – CMS hosts webinars in collaboration with WEDI. Webinars are recorded for download from the WEDI website, in the Education tab under Recorded Presentations.
  • Road to 10 – A CMS tool to help small practice physicians with an overview of ICD-10. This tool includes common codes and scenarios useful for physician specialties.

  • FAQs

    What does ICD-10 implementation mean to me?

    Answer: As a provider of health care services or items, you must report ICD-10 codes instead of ICD-9 codes for dates of service on or after Oct. 1, 2015. This requirement applies to all diagnosis and inpatient hospital procedure information you submit for all HIPAA compliant health care transactions, including the following:

    • Health care claim transactions

    • Requests for prior authorization or service agreements

    • Other diagnosis-related reporting or tier assessments (example: Health Care Homes complexity tiers)

    When will the Minnesota Health Care Programs (MHCP) be ready for ICD-10?

    Answer: MHCP will begin accepting ICD-10 codes on Oct. 1, 2015. We will deny claims submitted with ICD-9 codes for dates of service on or after this date.

    What can I do to prepare for ICD-10?

    Answer: We recommend all providers consider the many factors of ICD-10 implementation. You may want to take the following actions:

    • Contact your electronic health record vendor or clearinghouse to discuss preparation and testing.

    • Review information about ICD-10 preparation from each of the health care payers (insurance companies) you enroll or contract with.

    • Test with MHCP. See the Provider Testing section of this page.

    Additional Resources

    AHIMA ICD-10 CM/PCS American Health Information Management Association (AHIMA)

    CDC ICD-10-CM Centers for Disease Control and Prevention (CDC)

    CMS ICD-10 Overview CMS

    CMS ICD-10 Quick Reference (PDF)

    MHIMA ICD-10 Minnesota Health Information Management Association

    Sign up for CMS ICD-10 Industry Email Updates to stay up to date on ICD-10 information.

    * International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System


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