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ICD-10 Implementation

Welcome to the Medicaid ICD-10 webpage. Here you will find information about the Kentucky Department for Medicaid Services plans for ICD-10 implementation.

Please check back frequently for updates to this page.

What's New

ICD-10 Compliance Date Is Oct. 1, 2015

Reminder: the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

The rule requires the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

For resources on transitioning to ICD-10, visit the CMS ICD-10 website.

ICD-10 Testing Information

The Department for Medicaid Services, in conjunction with its MMIS fiscal agent, HP Enterprise Services will begin testing Aug. 18, 2014.

For questions regarding testing, contact the EDI Helpdesk.

Notice Final Rule posting

This final rule changes the compliance date from Oct. 1, 2014 to Oct. 1, 2015 for the ICD-10-CM for diagnosis coding and the ICD-10-PCS for inpatient hospital procedure coding, including the official ICD-10-CM and ICD-10-PCS guidelines for coding and reporting. It also requires the continued use through Sept. 30, 2015 of the ICD-9-CM for diagnoses and procedures including the ICD-9-CM guidelines for coding and reporting.

Notice to All Stakeholders

Due to passage of House Resolution 4302, the Department of Health and Human Services cannot adopt the ICD-10 code set as the standard until at least Oct. 1, 2015. The Kentucky Department for Medicaid Services and Hewlett Packard Enterprise will continue to move forward toward remediating the fiscal agent system and conducting end-to-end external testing by Oct. 1, 2014. Providers and clearinghouses are encouraged to contact HP EDI helpdesk to participate when external testing begins June 2014.

DMS will continue to post updates to this site as more information about the delay and new implementation timelines are available.

If you have questions, you may submit them through the mailbox.

ICD-10 Testing Information

The Department for Medicaid Services, in conjunction with its MMIS fiscal agent, HP Enterprise Services, highly recommends conducting end-to-end testing. HP plans to begin testing in July.

To be a beta tester, please e-mail the EDI Helpdesk with the following information:

  1. Your trading partner ID with Kentucky Medicaid
  2. Company name
  3. Testing contact information
  4. Testing contact:
  5. E-mail address:
  6. Phone number:
  7. Type of claim you are testing
  8. Notifications from Kentucky Medicaid (if different from testing contact)
  9. Contact name:
  10. E-mail address

Future ICD-10 information, such as testing dates, testing environments and guidelines will be sent to the trading partner contact you designate in your response.

Also read the General Provider Letter Regarding ICD-10 Readiness (Apr. 2, 2014)

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Background

Health care coding systems are used to differentiate diagnoses and procedures in virtually all treatment settings. These codes are integrated in systems and business processes in provider organizations and health plans as well as allied businesses. Proper coding is essential in all reimbursement and claim processes.

Currently, the U.S. Department of Health and Human Services uses the World Health Organization International Classification of Diseases, Ninth Edition, known as ICD-9.

In a final rule issued Jan. 16, 2009, ICD-10-CM (clinical modification - diagnoses) and ICD-10-PCS (procedural coding system - for inpatient procedures) will become the new coding system for delineating medical diagnoses and procedures for care management and billing purposes.

Originally slated to go into effect on Oct. 1, 2013, the date was later changed to Oct. 1, 2014.

This transition from ICD-9 to ICD-10 is a provision of the Health Insurance Portability and Accountability Act. The change to ICD-10 does not affect current procedural terminology coding for outpatient procedures.

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Transitioning Is Not Optional

The federal mandate to transition to ICD-10 pertains to all HIPAA-covered entities including providers, payers, vendors and their business associates. Provider claims not submitted using ICD-10 codes will be pended, denied or rejected. Payments to providers cannot be made without the proper ICD-10 coding. ICD-10 will affect all HIPAA-covered entities, not just those submitting Medicare or Medicaid claims.

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The Benefits of ICD-10

ICD-10 is vital to transforming our nation's health care system. As medical science continues to evolve, so will ICD-10, with benefits including:

  • A robust coding infrastructure that contains valuable information to help providers increase case management and care coordination effectiveness.
  • Improved quality measurements and patient safety, and the evaluation of medical processes and outcomes.
  • The capability to readily expand and capture new procedures and technologies.

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How do I prepare the ICD-10 transition?

It is important to start preparing now for the ICD-10 transition. Here are steps you can take to get started:

KY Medicaid Providers

  • Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, training, and budget. Check with your billing service, clearinghouse or practice management software vendor about their compliance plans.
  • Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT and finance staff to coordinate ICD-10 transition efforts.

Software vendors, clearinghouses, and billing services

  • Have products and services in development that will allow KY Medicaid providers to fully test and implement ICD-10 code sets prior to Oct. 1, 2015.
  • Talk to your customers now about preparing for the transition. Your products and services will be obsolete if you do not take steps now to get ready.

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Do you have questions? Would you like to recieve updates on ICD-10?
 

If you have questions about KY Medicaid ICD-10, email the CHFS DMS ICD-10 Questions mailbox.

To receive e-mail notices about the KY Medicaid ICD-10, subscribe and manage your news subscriptions.

 

Last Updated 9/29/2014
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