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June 30, 2015
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.
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 codes impact all providers in every health care setting.
The ICD-10 implementation requires operational changes of the following for both providers and MHCP:
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
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.
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.
MHCP is offering a phased, end-to-end testing for the transition to ICD-10. The phases are as follows:
DHS will not be providing training on ICD-10 coding. Visit the following websites regularly for the latest news, resources, webinars and training:
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.
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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