Nebraska Medicaid Program
Nebraska Medicaid ICD-10 Implementation Project
Frequently Asked Questions
Last Updated: 03/05/14
Here are some frequently asked questions and answers about the Nebraska Medicaid ICD-10 Implementation Project. If you don’t find your questions and answers here, contact DHHS.ICD-10Implementation@Nebraska.gov
What is ICD-10?
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
Who has to transition to ICD-10?
All covered entities under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 must implement the new code sets by October 2014. Covered entities required to use the new code sets include health plans, payers, providers, clearinghouses, health care information system vendors, billing agents and other services.
In addition, others affected by the change to ICD-10 will be coding staff; non-physician clinicians/ancillary departments; quality management; utilization management staff; quality staff; researchers/data analysts/epidemiologists, software vendors; information systems, billing/accounting; compliance officers; auditors, fraud investigations; and government agencies.
For HIPAA-covered entities transition to ICD-10 is not an option. Without ICD-10, providers will experience delayed payments or even non-payment; increased rejected, denied or pending claims; reduced cash flows and ultimately lost revenues. Payments to providers cannot be made without the proper ICD-10 coding.
Claims for all services and hospital inpatient procedures performed on or after October 1, 2014, must use ICD- 10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes.
Will ICD-10 replace CPT or HCPCS procedure coding?
No, the CPT (Current Procedure Terminology) and HCPCS (Healthcare Common Procedure Coding System) will continue to be used in the outpatient setting and for practitioner claim forms. Like ICD-9 procedure codes, ICD-10- PCS codes are for hospital inpatient procedures only.
What happens to ICD-9?
ICD-10 code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
Develop an implementation plan, communicate the new system changes to your organization, and ensure that leadership and staff understand the extent of the effort the ICD-10 transition requires.
Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, work flow changes during and after implementation, and contingency planning.
Talk with your payers, billing and IT staff, and vendors to confirm their readiness status.
Coordinate your ICD-10 transition plans among your partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
Create and maintain a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, needed resources, and estimated start and end dates.
Providers should plan to test their ICD-10 systems early, to help ensure compliance.
To find out more, see the CMS implementation timelines and implementation handbooks tailored for specific audiences, which are available at www.cms.gov/ICD10.
What should software vendors, clearinghouses, and third-party billing services be doing to prepare for the transition to ICD-10?
Software vendors, clearinghouses, and third-party billing services should be working with customers to install and test ICD-10 ready products. Take a proactive role in assisting with the transition so your customer can get their claims paid. Products and services will be obsolete if steps are not taken to prepare.
CMS has resources to help vendors and their customers prepare for a smooth transition to ICD-10. Visit www.cms.gov/ICD10 to find out more.
Are there any tools available to assist with the implementation?
The CMS website is a good resource at www.cms.gov/ICD10.
Will ICD-10 be required on Dental Claims?
Nebraska Medicaid does not currently require diagnosis codes on dental paper and electronic claims (HIPAA X12 837D) and will not require diagnosis codes with the implementation of ICD-10 on October 1, 2014. Claims will not be rejected if a valid diagnosis code(s) is submitted.
When will testing begin with trading partners?
Nebraska Medicaid plans to begin ICD-10 electronic transaction testing with trading partners April 1, 2014. See Provider Bulletin #14-02 for detailed information.
Will CMS extend the October 1, 2014, implementation date? CMS has announced that there are no plans to extend the compliance date for implementation of ICD-10-CM/PCS; therefore, covered entities should plan to complete the steps required to implement ICD-10-CM/PCS on October 1, 2014.
How long after the October 1, 2014, ICD-10 compliance date must I continue to report and/or process ICD-9 codes? Claims for dates of service prior to October 1, 2014, must be submitted with ICD-9 codes, regardless of the date submitted. Please note:
The Nebraska Medicaid claim filing deadline changes effective September 1, 2013, from within one (1) year to six (6) months of the date of service. See Provider Bulletin #13-50 for details.
A provider should also factor in how long they need to be able to report ICD-9 for claim adjustments that can be submitted up to 90 days from the payment date of the Remittance Advice and for exceptions to the 6 month timely filing rule. For exceptions to this rule, see 471 NAC 3-002.01A at Payment for Medicaid Services.
In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, the DSM-5 was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?
ICD-10 codes must be submitted for dates of service on or after October 1, 2014. Providers should discuss with coders, billing staff, IT staff, office management software vendors, clearinghouses, trading partners, etc., to ensure that they will be prepared to code and submit ICD-10 on or after October 1, 2014. See Provider Bulletin #13-36 for more detail.
Implementation of ICD-10 codes is just a computer system fix, right?
No. While the software upgrades and clearinghouse readiness are extremely critical to the successful submission of ICD-10 codes, the clinical documentation and diagnosis coding are just as critical. Each provider is responsible for the needed changes to their clinical documentation and diagnosis coding. Additionally, reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers. The CMS ICD-10 Planning Check List on the CMS website outlines the critical steps for providers to follow to accomplish implementation of ICD-10 codes.
What is “dual processing”?
For Nebraska Medicaid, dual processing means that both ICD-9 and ICD-10 codes will be accepted on and after 10-1-2014, but only
if submitted as follows:
ICD-9 will only be accepted for processing if the dates of service are before 10-1-2014.
ICD-10 will only be accepted for processing if the dates of service (“to” date or discharge date) are on or after 10-1-2014.
Effective January 6, 2014, Nebraska Medicaid will begin receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
Effective January 6 through March 31, 2014, Nebraska Medicaid will have a dual use and processing period during which we will continue to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
Effective April 1, 2014, Nebraska Medicaid will receive and process paper claims submitted only on the revised CMS 1500 claim form (version 02/12).
Note that on or after April 1, 2014, any claims received utilizing the older versions of the CMS 1500 claim form will be returned to the provider. See the Provider Bulletin #13-75: http://dhhs.ne.gov/medicaid/Documents/pb1375.pdf
for additional information.
Do not use ICD-10 codes prior to October 1, 2014.
ICD-10 codes can be used effective October 1, 2014, but only for dates of service on or after October 1, 2014.
If ICD-10 codes are submitted before October 1, 2014, the claims will be denied.
Each healthcare encounter should be coded to the highest level of specificity known for that encounter.
Due to the greater number of code choices in ICD-10-CM, the need for unspecified codes should be reduced.
Unspecified codes should be reported when they most accurately reflect what is known about the patient’s condition at the time of that particular encounter.
When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code.
It is inappropriate to select a specific code that is not supported by the medical record documentation, or to conduct diagnostic testing solely to determine a more specific code.
The use of unspecified codes may result in claims being denied or pended for additional documentation.
What is Nebraska Medicaid’s Test Plan for electronic claims?
The test plan for electronic transaction testing with trading partners is detailed in Provider Bulletin #14-02: http://dhhs.ne.gov/medicaid/Documents/pb1402.pdf Testing will begin April 1, 2014.
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