As of Oct. 1, 2014, all providers billing Arkansas Medicaid will be required by the United States Department of Health and Human Services (HHS) to use billing codes outlined in the International Classification of Diseases, 10th Edition (known as ICD–10). The federal mandate requires all health plans, clearinghouses and healthcare providers to use ICD-10 diagnosis and procedure codes. Arkansas Medicaid already has begun preparing for the shift to ICD-10.
The International Classification of Diseases, 10th Edition (ICD-10) consists of two parts:
1. ICD-10-CM (Clinical Modification) for diagnosis coding
2. ICD-10-PCS (Procedure Coding System) for inpatient procedure coding.
ICD-10-CM is used in all U.S. health care settings and uses 3 to 7 alphanumeric characters instead of the current 3 to 5 digit codes (numeric, with the exception of E and V codes) used by ICD-9-CM, Volume 1 & 2 diagnosis codes. ICD-10-PCS is used for inpatient procedures and uses 7 alphanumeric characters instead of the 3 to 4 numeric digits of ICD-9-CM, Volume 3.
The Arkansas Medicaid (www.medicaid.state.ar.us
) and this website will be updated throughout the ICD-10 implementation process, including with information about opportunities for trainings. Please check back frequently for important updates.
|Recently Added FAQs
||August 2, 2013 |
Question: Is the 6 month in reserve for the physician or because the insurers will not be able to pay?
Response: This is a general industry opinion for cash in reserve. There is a concern that some payer systems may not be fully transitioned and able to accept an ICD-10 code. There is also the concern that providers may not have the coding resources they need to submit claims in the required ICD-10 format. One suggestion for providers to prepare for the transition to ICD-10 was to secure a line of credit to keep their office operational.
Question: Can we get ICD-10 books now?
Response: Yes. The 2013 draft ICD-10 code books can be ordered now from several vendors. Optum is one vendor but there are several. You can look on the AAPC website or use Google to find resources.
Question: I obtained a list of translated codes for my top diagnoses last year; are these codes still accurate?
Response: There have not been many changes to the ICD-10 draft code sets. The Coordination & Maintenance Committee posts the changes on the CMS website. You can look there to verify if any codes have changed and you could also check the GEMS mappings (also posted on the CMS website) or verify the codes using an ICD-10 code book.
Question: Will Arkansas Medicaid be doing testing with Gateway EDI? When will Medicaid be ready to test with my EDI vendor?
Response: Medicaid will test with vendors who express a desire to test with us. Although a final date for testing has not been determined; it is anticipated that testing will begin in the 4th quarter of 2013. Information regarding testing will be distributed via the normal communication channels as well as being posted on the AR ICD-10 website.
Question: What about Worker’s Comp and MVAs claims - what code set will we use for submission of these claims?
Response: Currently Worker’s Comp claims and MVA claims are not included in the transition to ICD-10. However, the ICD-9 codes will not be maintained or updated following the transition to ICD-10 so codes may not be accurate in the future. You should communicate with carriers to determine what code set they will accept post October 1, 2014.
Question: How do we engage the physicians and get them to believe the change to ICD-10 is really going to happen?
Response: There are many ways to engage physicians in the work effort that will help them understand the importance of this transition. The American Medical Association (AMA) has published a book that will guide the physician in the remediation efforts of the change to ICD-10. The book is approximately $80 and can be ordered on the AMA website. Providers don’t have to be a member of the AMA to order the book.
Other ways to engage providers include asking them to teach a refresher course on Anatomy & Physiology at the local hospital. Work collaboratively with the Health Information Management Director to see if you can participate in any educational opportunities they may be offering in exchange for your providers teaching refresher classes on specific disease processes such as Diabetes, Acute Myocardial Infarctions and Obstetric related conditions.
Question: Will Arkansas Medicaid be teaching coding classes?
Response: Medicaid will not be providing classes that teach participants how to code. There are many resources available that provide ICD-10 training as well as Coding Boot Camps. In addition to the American Health Information Management Association (AHIMA) and the American Academy for Professional Coders (AAPC), attendees should check with the Arkansas Association for Health Information Management and the Arkansas Hospital Association for educational offerings that are held locally.
Question: Where can I find information on the new codes?
Response: There are several resources available on the internet. ICD10 Watch, AHIMA and the Centers for Medicare & Medicaid all provide resources and information that will provide the educational content that is required to evaluate, understand and implement ICD-10.
Question: Will providers have the ICD-10 codes available when a member is seen for their annual evaluation?
Response: It is doubtful that providers will have translated their ICD-9 diagnosis codes to ICD-10 codes this far in advance. Case Managers can use this opportunity to educate the provider offices regarding the transition from ICD-9 to ICD-10 if the provider does not appear to be aware of the changes coming in 2014.
Question: Do the ICD-10 codes specify the IQ level for Intellectual Disabilities?
Response: Yes. The following is an excerpt from the 2013 DRAFT ICD-10 CM Code Book: Intellectual Disabilities (F70 – F79)
F70 Mild intellectual disabilities – IQ level 50 – 55 to approximately 70 (Mild mental subnormality)
F71 Moderate intellectual disabilities – IQ level 35 – 40 to 50 – 55 (Moderate mental subnormality)
F72 Severe intellectual disabilities – IQ level 20 – 25 to 35 - 40 (Severe mental subnormality)
F73 Profound intellectual disabilities – IQ level below 20 – 25 (Profound mental subnormality)
Question: How do we get providers to be more specific in their documentation?
Response: This issue is being addressed across the healthcare community. The American Medical Association has recently published several resources that can be obtained on their website at http://www.ama-assn.org
. In addition, hospitals and integrated delivery networks across the country are working with providers to improve their documentation as a result of electronic health records as well as the transition to ICD-10.
Question: The presentation contains codes related to unspecified head injury but many of our clients have traumatic brain injury. Can we get those code translations?
Response: The status of a traumatic brain injury is currently reflected with a V-code as noted below. If the member is being seen for the initial injury the code would be assigned based on the type of injury, the location of the injury within the brain and the length of time the member was unconscious. There are 80 ICD-10 codes for traumatic brain injury in the 2013 DRAFT ICD-10 CM Code Book.
|CMS FAQs for ICD-10 Billing
||June 13, 2013 |
CMS has released three FAQs about submitting ICD-10 claims around the October 1, 2014, deadline. These FAQs update previous information about submitting claims and explain how to split claims for services that span the October 1, 2014, transition date.
The three FAQs on ICD-10 billing discuss these topics:
How do I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2014 to on or after 10/1/2014? (#8246)
If I submit or process a transaction with an ICD-9 code for a date of service after October 1, 2014, am I HIPAA compliant? (#8248)
How long after the October 1, 2014 ICD-10 compliance date must I continue to report and/or process ICD-9 codes? (#8252)
You can find these questions and many other FAQs about ICD-10 at https://questions.cms.gov.
Information from the Center for Medicare and Medicaid Services can be found at www.cms.gov/ICD10
Information about the American Health Information Management Association cane be found at www.AHIMA.org
Other helpful websites include:
If you want more information or have questions about Arkansas Medicaid ICD-10 implementation, please contact ICD10DMS@arkansas.gov