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ICD-10

IMPLEMENTATION (GO-LIVE) DATE:

October 1, 2015

GENERAL ICD-10 INFORMATION

NEW:  Wyoming Medicaid ICD-10 Test Results - Executive Summary

NEW: ICD-10 Claim Denials, Edits and Policy Considerations 10.07.2015

ICD-10 CODING INFORMATION

The International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10) is a diagnosis coding system of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases and a procedure coding system for inpatient procedures. It consists of two parts:

1. ICD-10 CM for diagnosis coding

  • This is for use in all health care settings
  • Diagnosis coding under ICD-10 uses 3 to 7 alphanumeric digists instead of the 3 to 5 digiits used with ICD-9

2. ICD-10 PCS for Inpatient procedue coding

  • This is for use in inpatient hospital settings
  • Coding under ICD-10 uses 7 alphanumeric digits instead of 3 to 4 digits used with ICD-9

There are currently 13,000 codes in ICD-9 as which will be expanded to 68,000 codes in ICD-10. Instead of 3,000 surgical procedure codes, the new PCS contains approximately 87,000 codes. The length has expanded up to 7 bytes.

  • Medicaid does not conductany coding training

IMPORTANT BILLING INFORMATION

ICD-10 Implementation is Date of Service specific:

1. Dates of service prior to 10/01/15 MUST be billed with an ICD-9 diagnosis/surgical procedure code.
2. Dates of service 10/1/15 and after MUST be billed with an ICD-10 diganosis/surgical procedure code.
3. Inpatient services that span September 2015 - October 2015 MUST have ICD-10 coding requirements as the "through" date of service will determine the appropriate coding.

DSM 5 information

1. 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 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

2. 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, http://www.dsm5.org.

CMS 1500 Claim Form:

1. Effective July 1, 2014, Wyoming Medicaid will transition from the current professional claim form [CMS 1500 (08-05)] to the new professional claim form (CMS 1500 (02-12)].

2. New CMS-1500 Claim Form Bulletin

ARE YOU READY? MEDICAID IS!

A wide variety of healthcare organizations and physicians will need to prepare for the upcoming ICD-10 transition. As a result, providers will need to develop plans for IT and training of staff. The transition may be quite difficult.

Wyoming Medicaid has already done the necesary updates within our Secure Provider Web Portal and WINASAP systems to ensure readiness for ICD-10. If your practice is using those systems to submit claims, no further action is required by you. If your practice is using software that is being uploaded through the web portal, you will need to check with your vendor to see if their software is ready.

Wyoming Medicaid is not requiring that software be tested. However, if you or your vendor is using software and want to test, it can be tested through the EDIFECS site, Information regarding the steps for testing can be found in Chapter 9 of any provider manual on the website in Section 9.5. When contacting EDI Services please provide the following information:

1. Wyoming Trading Partner ID number
2. Name of software or organization
3. Contact name
4. Contact phone number
5. Contact email address

NOTE If you or your vendor has tested previously with EDIFECS (i.e. HIPAA 5010), your same login information is still valid.

CONTACTS / RESOURCES

ICD-10 and testing questions can be directed to:

  • EDI Serivces, 800-672-4959, press 3.


Center for Medicare & Medicaid Services ICD-10 Provider Resources
MLN (Medicare Learning Network) ICD-10 Basics Video
Version 5010 Industry Resources
MLN General Information
American Academy of Family Physicians (AAFP)
American College of Cardiology (ACC)
American Academy of Professional Coders (AAPC)
America College of Physicians (ACP)
American Health Information Management Association (AHIMA)
American Hospital Association (AHA)
American Medical Association (AMA)
American Medical Billing Association ((AMBA)
Healthcare Billing and Management Association (HBMA)
Healthcare Information and Management Systems Society (HIMSS)
Leading Age
National Association of Community Health Centers (NACHC)
National Rural Health Association (NRHA)
Medical Group Management Association (MGMA)
Professional Association of Health Care Office Managers

Bulletins

ICD-10 Important Facts and Dates
ICD-10 IMPLEMENTATION OCTOBER 1, 2015
ICD-10 Implementation
Wyoming Medicaid ICD-10 Information

External Linking Policy

This page contains external links that are not the responsibility of, or under the control of, the Wyoming Medicaid Program. Wyoming Medicaid does not endorse any commercial products, services or web sites. The Wyoming Medicaid Program may not be held liable for the informational content or services provided on any external web sites which link from the Wyoming Medicaid web site.