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Michigan Medicaid Claims Processing Guidance for Implementing the International Classification of Diseases, 10th Edition (ICD-10)

Michigan Medicaid Claims Processing Guidance for Implementing the International Classification of Diseases, 10th Edition (ICD-10)

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Published by Beverly Tran
This bulletin addresses reporting guidelines, claims submissions, and date span requirements for ICD-10 and applies to both Fee-for-Service (FFS) claims and encounters.

Affected Programs: Medicaid, Adult Benefits Waiver (ABW), Children’s Special Health Care Services (CSHCS), Children’s Waiver Program (CWP), Children’s Serious Emotional Disturbance Waiver (SEDW), Maternity Outpatient Medical Services (MOMS), Plan First!, and other Health Care Programs administered by MDCH
This bulletin addresses reporting guidelines, claims submissions, and date span requirements for ICD-10 and applies to both Fee-for-Service (FFS) claims and encounters.

Affected Programs: Medicaid, Adult Benefits Waiver (ABW), Children’s Special Health Care Services (CSHCS), Children’s Waiver Program (CWP), Children’s Serious Emotional Disturbance Waiver (SEDW), Maternity Outpatient Medical Services (MOMS), Plan First!, and other Health Care Programs administered by MDCH

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Published by: Beverly Tran on Jul 19, 2013
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03/06/2014

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MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
NOTICE OF PROPOSED POLICY
Public Act 280 of 1939, as amended, and consultation guidelines for Medicaid policyprovide an opportunity to review proposed changes in Medicaid policies and procedures.Please review the policy summary and the attached materials that describe the specificchanges being proposed. Let us know why you support the change or oppose the change.Submit your comments to the analyst by the due date specified. Your comments must bereceived by the due date to be considered for the final policy bulletin.Thank you for participating in the consultation process.Director, Program Policy DivisionBureau of Medicaid Policy and Health System Innovation
 
ProjectNumber:
1331-ICD
CommentsDue:
August 16, 2013
ProposedEffective Date:
As Indicated
Mail Comments to:
Carmen StarkweatherBureau of Medicaid Policy and Health System InnovationMedical Services AdministrationPO Box 30479Lansing, MI 48909
Telephone Number:
(517) 241-4716
Fax Number:
(517) 335-5136
 E-mail Address:
starkweatherc@michigan.gov
Policy Subject:
Claims Processing Guidance for Implementing the International Classification of Diseases, 10thEdition (ICD-10)
 Affected Programs:
Medicaid, Adult Benefits Waiver (ABW), Children’s Special Health Care Services(CSHCS), Children’s Waiver Program (CWP), Children’s Serious Emotional Disturbance Waiver (SEDW),Maternity Outpatient Medical Services (MOMS), Plan First!, and other Health Care Programs administered byMDCH
 
Distribution:
All Providers
 Policy Summary:
 This bulletin addresses reporting guidelines, claims submissions, and date spanrequirements for ICD-10 and applies to both Fee-for-Service (FFS) claims and encounters.
Purpose:
For dates of service on and after October 1, 2014, entities covered under the Health InsurancePortability and Accountability Act (HIPAA) are required to use the International Classification of Disease, 10thEdition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) code sets in standardtransactions adopted under HIPAA. The HIPAA standard health care claim transactions are among those forwhich ICD-10 codes must be used for dates of service on and after the compliance date. The ICD-10-CM and ICD-10-PCS code sets will be required for diagnosis reporting in all covered health caresettings and procedure reporting for inpatient hospital claims effective with dates of service on or after October1, 2014. The information contained in this bulletin is intended to assist providers in preparing their business andsystems’ changes for this transition.
Public Comment Cover (07/11)
 
 
Michigan Department of Community HealthMedical Services Administration
Distribution:
All Providers
Issued:
September 1, 2013 (proposed)
 Subject:
Claims Processing Guidance for Implementing the International Classification of Diseases, 10
th
Edition (ICD-10)
 Effective:
As Indicated (proposed)
 Programs Affected:
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),
PlanFirst!,
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
th
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:

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