Michigan Department of Community HealthMedical Services Administration
September 1, 2013 (proposed)
Claims Processing Guidance for Implementing the International Classification of Diseases, 10
As Indicated (proposed)
Medicaid, Adult Benefits Waiver (ABW), Children’s Special Health Care Services(CSHCS), Children’s Waiver Program (CWP), Children’s Serious EmotionalDisturbance Waiver (SEDW), Maternity Outpatient Medical Services (MOMS),
and other Health Care Programs administered by MDCH This policy bulletin provides information about the Michigan Department of Community Health’s (MDCH)implementation of the International Classification of Disease, 10
Edition, Clinical Modification and ProcedureCoding System (ICD-10-CM/ICD-10-PCS) code sets. This information is intended to assist providers in preparingtheir business and systems’ changes and applies to both Fee-for-Service (FFS) claims and encounters. Futurepolicy bulletins will address ICD-10 diagnosis coding for Medicaid service coverage, limitations, and priorauthorization requirements. The use of other code sets, such as Current Procedural Terminology (CPT)
,Healthcare Common Procedure Coding System (HCPCS) Level II, and revenue codes, will not be impacted bythis change.
Reporting of ICD-10-CM Diagnosis Codes
For dates of submission beginning October 1, 2014, MDCH will adhere to the following:
On professional and dental claims, ICD-10 diagnosis codes must be used with FROM dates of service on orafter October 1, 2014.
On institutional claims, ICD-10 diagnosis codes must be used with DATES OF DISCHARGE/THROUGHdates that occur on or after October 1, 2014.
A claim cannot contain both ICD-9 codes and ICD-10 codes: The claim will be denied if a combination of codes is submitted on and after the October 1, 2014 implementation date. Services should be split into twoclaims so all ICD-9 codes remain on one claim with dates of service (DOS) through 9/30/2014 and all ICD-10codes are placed on the other claim with DOS beginning 10/1/2014 and later.For Dates of Service spanning the ICD-10 implementation date:
On professional and dental claims, the FROM date of service is used to determine the split for claimsubmission; on institutional claims, the DATES OF DISCHARGE/THROUGH dates are used.
There are certain exceptions where billing policy does not allow splitting the claim. The following tableprovides additional guidance to providers for these exceptions: