ICD-10 Frequently Asked Questions (FAQs)
If you're like other providers, vendors, and stakeholders in the
International Classification of Diseases, Tenth Revision (ICD-10)
Compliance Project, you have questions about how ICD-10 will work.
ICD-10 questions and answers are on the agenda of monthly ICD-10
update presentations, in Indiana Health Coverage Programs (IHCP)
publications, and on this FAQ page.
The questions and answers on this page are divided into the
following topics:
ICD-10 Questions mailbox
If you have any ICD-10-related questions that you would like the
ICD-10 team to address, please submit your questions to INXIX.ICD10Questions@HP.com.
We will answer your question and we may add it, along with the
answer, to the questions and answers on this FAQ page.
ICD-10 Schedules and Time frames
Q. What is the time frame for implementing ICD-10?
A. The Family and Social Services
Administration (FSSA) and HP Enterprise Services (HP) have
completed initial assessments of the Medicaid Management
Information System (MMIS) and are now on target for the October 1,
2013, implementation of the ICD-10 code sets.
Q. Will there be regular meetings for stakeholders?
A. The FSSA ICD-10 team is presenting
information about ICD-10 at association meetings and meetings with
managed care entities. The HP ICD-10 team and HP Provider Relations
Field Consultants are also presenting updates at association
meetings, provider workshops, and seminars.
Q. Is there going to be a freeze in claims processing?
A. For providers or any system processors,
there will not be a freeze on claims processing, enrollment of
providers, eligibility, or the Help Desk.
However, there will be a freeze on updating the ICD codes as of
October 1, 2012--see the link to the CMS article about the
Partial Code Freeze Prior to ICD-10 Implementation on the
ICD-10 Information page.
ICD-10 Impact,
Assessment, and Benefits
Q. How is using the ICD-10 code sets going to help control
healthcare costs and improve patient care?
A. An accounting of the cost control and
improvements to patient care and claims processing is outlined in
the news release from the U.S. Department of Health and Human
Services office titled, HHS Issues
Final ICD-10 Code Sets and Updated Electronic Transaction Standards
Rules, that is available from the HHS website at hhs.gov.
Here is an assessment of ICD-10's projected impact from an April
2011 CMS ICD-10
Regional Office Training Workshop to help state Medicaid agencies
with ICD-10 implementation:
"State Medicaid agencies can pay more accurately based on the
greater specificity and granularity of ICD-10 codes… Fine tuning
case management and disease management... the increased granularity
of codes results in substantially more parameters of diagnosis
codes that provide much greater insights into characteristics of
patients' health state."
Q. Do providers of Medicaid Waiver (only) services need to be
concerned about ICD-10?
A. All providers that use International
Classification of Diseases, Ninth Revision (ICD-9) codes need to be
aware of, and comply with, the requirement to migrate from ICD-9 to
the International Classifications of Disease, Tenth Revision
(ICD-10), on October 1, 2013. Providers of Medicaid Waiver services
will need to stay informed regarding program requirements
associated with the use of the ICD code set.
Q. What opportunities does the change to ICD-10
provide?
A. The top 10 opportunities in the change from
ICD-9 to ICD-10 are:
- Greater congruence with technological advances in
healthcare
- Improved care and disease management
- Enhanced quality measures
- Enhanced medical policies
- Improved claims payment accuracy and efficiency
- Greater granularity in severity and risk definitions
- Enhanced clinical information integration
- Greater forward flexibility--ICD-10's alphanumeric format
allows for future revision of codes without disrupting the
numbering system
- More detailed medical concepts
- Enhanced code specificity
Q. Who is affected by ICD-10?
A. All providers and vendors that use ICD-9
codes need to comply with the requirement to transition from ICD-9
to ICD-10, effective October 1, 2013.Those billing for Medicaid
services need to stay informed regarding program requirements
associated with using the ICD-10 code set.
Q. Everything I read states we should be getting ready for
ICD-10. Where do I start?
A. Begin by accessing the ICD-10 Training
page on this site for links to the CMS ICD-10 Implementation
Handbooks and the ICD-10 and Version 5010 Compliance Timelines
Widgets. These publications are free and provide detailed guidance
for assessment and planning for ICD-10.
Q. What should we be doing about our computer systems?
A. Review your file layouts and where your
files are stored to be sure the fields and your system can
accommodate the additional code length. Contact your software
vendor to resolve concerns. Here are other ways to prepare:
- Familiarize yourself with the ICD-10 code set and coding
guidelines to help assess the impact on your system.
- Note that the CMS-1500 form is in revision, and the diagnosis
codes are expanding from four to 12 entries. Watch for
information about the new release of this form.
- Do not stop assessment and planning while awaiting the final
decision by CMS about implementation.
ICD-10 Testing
Q. Will there be vendor testing?
A. Vendor testing is scheduled to begin January
1, 2013.
Q. When will test plans for the managed care entities (MCEs)
and vendors be available?
A. MCE and vendor test plans will be available
in second-quarter 2012.
ICD-10 Prior Authorization
Q. How is prior authorization (PA) affected by ICD-10 and the
October 1, 2013, implementation date?
A. Providers will be able to submit ICD-10 PAs
beginning in July 2013, which will allow providers to submit ICD-10
diagnosis codes on the PAs when the REQUEST FROM date is on or
after October 1, 2013. Providers must split paper PA requests
between those with ICD-9 codes and those with ICD-10 codes.
The PA Request Form will undergo some changes and will be
available in time for the PA implementation date. The new form will
include a version indicator. Complete information about the
effective dates, the form, and any other information pertinent to
PA and ICD-10 will be communicated before implementation via a
bulletin.
Q. Will we be able to submit a PA for a service that is on or
after October 1, 2013, before October 1, 2013?
A. Yes. PA for a REQUEST FROM date on or after
October 1, 2013, may be submitted on or after July 1, 2013.
Information about the PA Request Form and how to submit the form
will be published in a bulletin before implementation.
Q. Can a paper PA request contain a REQUEST FROM date before
October 1, 2013, and after October 1, 2013, on the same form?
A. No. Paper requests for PAs with REQUEST FROM
dates before October 1, 2013 (with ICD-9 codes), must be on
separate PA Request Forms than those with REQUEST FROM dates on or
after October 1, 2013 (with ICD-10 codes).
ICD-10
CODES and Claims
Q. Why are we proceeding before the final versions of claim
forms are available? Do you know when final claim forms will be
available?
A. Due to the scope of the transition from
ICD-9 to ICD-10, if entities expect to be compliant by October 1,
2013 (as mandated by CMS), they must proceed with planning,
development, and implementation before updated versions of claim
forms are final. With respect to paper claim forms, the IHCP will
keep an eye on developments and notify providers when the updated
versions become available.
Q. Will providers and vendors be able to use International
Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM) codes after the October 1, 2013, implementation of
ICD-10?
A. You must use ICD-10 codes for dates of service (DOS) or dates
of discharge (DOD) on or after the October 1, 2013, implementation
date. There is no grace period.
Claims with ICD-9 codes and DOS or DOD before the implementation
date will continue to process as they do today.
Q. How are codes being validated on claim submissions in
ICD-10?
A. The code specificity validation check is
not changing. There will be no up-front validity
check for the letters "O" and "I."
Q. Why do the General Equivalence Mappings (GEMs) go in both
directions (from ICD-9-CM to ICD-10-PCS, and from ICD-10-PCS back
to ICD-9-CM)?
A. The GEMs are designed like a translation
dictionary. They go in both directions so you can look up a code to
find what it means according to the concepts and structure used by
the other coding system, similar to how Spanish-English and
English-Spanish dictionaries are designed. Neither the two
dictionaries nor the GEMs are mirror images of each other. Because
the translation alternatives are based on the meaning of the code
you are looking up (which includes index entries, tabular
instruction, and applicable Coding Clinic advice), the
ICD-10-Procedure Coding System (PCS) to ICD-9-CM GEM is not a
mirror image of the ICD-9-CM to ICD-10-PCS GEM.
The GEMs were designed to convert current ICD-9 codes to
applicable ICD-10 codes. Starting with an ICD-9-CM code, users can
map an ICD-10-PCS code to an ICD-9-CM GEM, and convert payment
logic or coverage decisions from ICD-9 codes to ICD-10 codes.
This ICD-10-PCS to ICD-9-CM GEMs mapping can also be used to
examine trend data over multiple years, spanning the implementation
of ICD-10. For example, in 2013, it will be possible to compare how
frequency changed for a specific condition using an ICD-10 code,
compared to prior years using an ICD-9 code.
Conversely, mapping an ICD-9-CM code to an ICD-10-PCS GEM can be
used to convert ICD-9-based edits, and for any analysis or
conversion that needs to examine ICD-10 codes and determine the
ICD-9-CM codes that previously captured this diagnosis or
procedure.
Bidirectional mapping is required because results may be
different based on clinical or terminology differences between the
two code sets.
For more information, see the CMS.gov
Frequently Asked Questions web page.
Q. Are a list of ICD-10 codes and the crosswalking information
for ICD-9 to ICD-10 available?
A. The current list of ICD-10 codes is
available for purchase from most online vendors. Some of the codes
may be accessed online by searching on "ICD-10 codes."
Crosswalking ICD-9 to ICD-10 codes is addressed in the CMS
General Equivalence Mappings (GEMs) publications available on the
CMS website. You can find a link to these publications on the
ICD-10 Training
page.
Consider subscribing to the CMS Email Updates to stay current on
what is happening with ICD-10. The sign-up for notifications from
CMS is available from the CMS website at cms.gov.
Q. Are there going to be changes to the CMS-1500 claim form as
a result of ICD-10? If so, what are the changes, when will the form
be published, and when are we expected to use it?
A. The CMS-1500 is currently in revision.
Although there is no date for publication at this time, the intent
is to have the form available in time to coincide with the
implementation of ICD-10.
The form will require a qualifier entry to differentiate between
ICD-9 and ICD-10 claims. Another proposed revision to the form is
to expand the number of diagnosis entries from four to 12. HP
will inform you when the revised CMS-1500 is approved and ready to
use.
Q. What about claims that span the October 1, 2013,
implementation date?
A. Mixing ICD versions will not be allowed. Any
claims that are submitted with mixed ICD versions will be rejected.
See the ICD-10
Decisions page for the breakdown of the ICD-10 span date logic
by claim type.
Q. Will the implementation of ICD-10 be based on date of
service or date of receipt for claims processing?
A. All claims received on or after October 1,
2013, will require a version indicator (ICD-9 = 9 or ICD-10 = 0).
Claims with date of service (DOS) on or after October 1, 2013, that
require diagnoses will be required to use ICD-10 diagnosis
codes.
Q. What claim types require ICD-10 codes?
A. All claim types except dental require ICD-10
codes.
Q. Will Medicaid accept claims with both ICD-10 and ICD-9
codes?
A. Medicaid will accept claims only if ICD-9
and ICD-10 are submitted on separate claims. Claims submitted with
both ICD-9 and ICD-10 codes will reject.
Q. Will Medicaid require the use of a decimal point on
electronic claim submissions?
A. No decimal point will be required on
electronic claim submissions.
Q. Is the IHCP going to publish the new ICD-10 codes that
relate to policies?
A. Yes. They will be published in bulletins
before ICD-10 implementation.