The U.S. Department of Health & Human Services released a final rule that includes the new ICD-10 compliance date of 10/1/15. This final rule implements Section 212 of the Protecting Access to Medicare Act of 2014 by changing the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) from 10/1/14 to 10/1/15. It also requires the continued use of the International Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (procedures) (ICD-9-CM) through September 30, 2015. The final rule was published in the Federal Register on August 4, 2014 and is available here.
All Ohio Medicaid providers using ICD-9 on a claim today will be required to use ICD-10 on a claim starting 10/1/15. There is no transition period; 10/1/15 is a hard date for compliance. The compliance date is based on: date of service for outpatient and professional services and date of discharge for inpatient hospital services. ICD-9 codes will continue to be used on claims with dates of service/discharge prior to 10/1/15. Providers cannot bill ICD-9 and ICD-10 codes on the same claim; only one code set per claim will be accepted into MITS. If your organization typically bills span dates and your span crosses the 10/1/15 compliance date, break the claim into two claims: one claim through September 30, 2015, and another claim from October 1, 2015 to last date of span. Paid claims that need adjusted will follow the same compliance date guidelines. If the claim is originally filed with the date of service/discharge prior to 10/1/15, ICD-9 will be required. If the claim is originally filed with the date of service/discharge on or after 10/1/15, ICD-10 will be required. Prior authorization requests that will span the 10/1/2015 compliance date will accept ICD-10 codes prior to 10/1/2015. If your organization submits claims directly to Ohio Medicaid’s MITS web portal, please be sure to select the appropriate ICD version indicator (ICD-9 or 10). Claims that do not use the ICD-10 codes for dates of service/discharge on or after 10/1/2015 will deny.
The ICD-10 code sets are available on CMS’s ICD-10 website. On the left side of this page, click on one of the following: 2015 ICD-10-CM and GEMs, or 2015 ICD-10 PCS and GEMs. ICD-10-CM are diagnosis codes and ICD-10-PCS are procedure codes. Hard copy ICD-10 code books are also available. Note: ICD-10-PCS will be used to report hospital inpatient procedures only. The Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) will continue to be used to report services and procedures in outpatient and professional settings; however, all claims (inpatient, outpatient, and professional) will require an ICD-10 diagnosis.
Please prepare your organization for the transition to ICD-10 now. If your organization is interested in testing with Ohio Medicaid, please contact our ICD-10 testing team at: MITS_CGTESTING@medicaid.ohio.gov. Testing information for trading partners is available here.
Continue to visit this webpage for updates related to ICD-10 implementation in Ohio.