The International Classification of Diseases, 10th Revision (ICD-10) medical coding system is mandated for use by the US Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) effective October 1, 2015. The new codes include enhanced specificity and level of detail, and the transition to the new codes will impact health care providers and trading partners.
RI Medicaid continues to provide education to providers through the monthly Provider Update and this website.
To help dispel some of the myths surrounding ICD-10, the Centers for Medicare and Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10. These facts address some of the common questions and concerns CMS has heard about ICD-10.
- The ICD-10 transition date is October 1, 2015. The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
- You don't have to use 68,000 codes. Your practice does not use all 13,000 diagnosis codes available in ICD-9. Nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
- You will use a similar process to look up ICD-10 codes that you use with ICD-9. Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
- Outpatient and office procedure codes aren't changing. The transition to ICD-10 for diagnosis coding and inpatient procedure codes does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT.
Provider and Vendor Readiness Information
- Assess staff training needs for the ICD-10 transition.
- Understand the ICD-10 code sets and begin developing a plan for how your facility will utilize the new codes.
- Review frequently used ICD-9 codes and crosswalk to ICD-10 codes.
- Use the resources on the website and visit often to check for updates.
Claim Billing Information
Claim Form Changes
ICD indicators have been added to claim forms. This indicator must match the version of the ICD diagnosis code being submitted. Please review the instructions for the claim form being submitted.
CMS 1500 form Instructions
UB 04 form Instructions
Waiver form Instructions
ICD-10 Code Information
Diagnosis coding is based on the documentation in the medical file for each client. Providers must ensure that the documentation in the record is sufficiently detailed to determine the most accurate diagnosis code that represents the client's condition. Information about ICD-10-CM (Clinical Modification) and ICD-10-PCS (Procedure Coding System) is available on the CMS ICD-10 website. Claims submitted with diagnosis codes that are not coded to the correct level of specificity will deny.
Diagnosis Codes Never to be Used as Primary Diagnosis
With the adoption of ICD-10, CMS designated that certain Supplementary Classification of External Causes of Injury, Poisoning, Morbidity (E000-E999 in the ICD-9 code set) and Manifestation ICD-10 Diagnosis codes cannot be used as the primary diagnosis on claims. Claims submitted with these diagnosis codes as primary will deny. To view the complete list of codes, click here.
Reminder: ICD-10 general category description codes can never be used as either primary or secondary diagnoses.
RI Medicaid is unable to provide a crosswalk for converting ICD-9 to ICD-10 codes. Crosswalks are not a substitute for fully implementing ICD-10. Providers may find the CMS General Equivalence Mappings (GEMs) a helpful tool, but GEMs are not an exact crosswalk between ICD-9 and ICD-10. Current ICD-9 codes often lack the level of specificity required to determine the correct ICD-10 code so the match may not be accurate. GEMs are not intended to replace coding based on the client's condition.
Selecting the ICD Version
Beginning October 1, 2015, providers will need to determine the version of ICD coding to use when submitting a claim to RI Medicaid for payment. Click here for a chart to help providers determine whether to use ICD-9 or ICD-10 codes on a claim.
Provider Electronic Solutions (PES) Software
The PES software has been modified to accommodate ICD-10 codes and now contains a qualifier to indicate if an ICD-9 or ICD-10 code is being submitted.
ICD-10 Teleconference Training
Hewlett Packard Enterprise and RI Medicaid conducted training sessions on ICD-10 in March and April. The training offered providers and vendors information and guidance to help prepare for implementation.
To view the presentation slides, select the link below:
ICD-10 Presentation Slides
Provider and Vendor Communications
ICD-10 updates are included in our monthly Provider Update. Broadcast emails are also sent to the distribution list. In some cases, provider specific emails will be sent to Medicaid providers who provide a specific service. To be added to the distribution list, send an email to firstname.lastname@example.org.
RI Medicaid provides links to valuable resources that support providers in the transition to ICD-10.
- CMS website - This website has comprehensive information on ICD-10 for all providers. Planning documents, checklists, and implementation guides for provider are also available.
- Road to 10 - The CMS resource offers physicians information specific for their specialization. There is also an interactive tool to create an action plan.
- Medscape, in collaboration with CMS, produced two helpful videos. The videos require that you set up a free account to view, entering a user name and password of your choice.
A Small Practice Guide to a Smooth Transition
A Roadmap for Small Clinical Practices
- ICD-10 FAQ (Updated February 25, 2015)
RI Medicaid provided an opportunity for all providers to test ICD-10 coded claims. The testing window is now closed.
Special ICD-10 Edition of the Provider Update
As a resource for providers, a Special ICD-10 Edition of the Provider Update is available, containing helpful information on ICD-10 implementation all in one place.