Nebraska Medicaid Program

Nebraska Medicaid ICD-10 Implementation Project

Frequently Asked Questions

Last Updated: 08/11/15
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.
 
BASIC ICD-10 INFORMATION

CODES

FEE-FOR-SERVICE CLAIMS 
DELAY

MENTAL HEALTH PROVIDERS

PROVIDER READINESS

RESOURCES

  1. Where can we find resources for assistance in preparing for ICD-10 implementation?

Nebraska resources
National resources
ICD-10 Code books

TESTING

TRADING PARTNER / CLEARINGHOUSE / SOFTWARE VENDOR / THIRD PARTY BILLING

QUESTIONS?

Vendors

BASIC ICD-10 INFORMATION

ICD-10 refers to the 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.

CODES

Information on the ICD-10 code sets can be found at www.cms.gov/ICD10.

ICD-10 codes are more modern, specific, and consistent with current medical practices than those of ICD-9.  Through the use of up-to-date medical terminology, ICD-10 will more accurately describe the new procedures and diagnoses reflected in modern medical practice.  The ICD-9 code set describes approximately 14,000 diagnosis and 4,000 procedure codes, but in today’s world these are insufficient to identify newly identified diseases and other medical advances.  For example, ICD-9 does not have a code for Ebola.

ICD-10 code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2 for diagnosis codes, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for inpatient procedure codes.

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 claims.

The ICD-10-CM and the ICD-10-PCS code sets, as well as the ICD-10-CM official guidelines, are available free of charge at www.cms.gov/ICD10

 Subscribe to the Nebraska Medicaid ICD-10 Implementation Project.  On the webpage, select the “  Click to subscribe ” button and enter your email address. Subscribers receive an email notification every time updates are made to the ICD-10 webpage.

No.  Nebraska Medicaid does not currently require diagnosis codes on dental paper or electronic claims (HIPAA X12 837D) and will not require diagnosis codes with the implementation of ICD-10 on October 1, 2015.  Claims will not be rejected if a valid diagnosis code(s) is submitted.

 Yes. Nebraska Medicaid requires ICD-9 diagnosis codes for dates of service prior to the implementation of ICD-10. While DSM-IV codes were designed to correspond with ICD-9 codes, they do not correspond to ICD-10 codes. Mental health providers must transition to ICD-10 in order to have claims considered for payment after October 1, 2015.

FEE-FOR-SERVICE CLAIMS

ICD-9 codes can be billed after October 1, 2015 but only for dates of service prior to October 1, 2015. Please see Provider Bulletin 15-22 for detailed information.

The date of service determines the compliant code set to use on a claim regardless of the date the claim is filed or submitted. Providers can submit claims after October 1, 2015 with ICD-9 codes when the services were performed prior to October 1, 2015. Payers will process claims if received after October 1, 2015 with ICD-9 codes when the services were performed prior to October 1, 2015. This situation is HIPAA compliant.

Your claim will be denied. Please note:

  • If ICD-10 codes are submitted before October 1, 2015, the claim will be denied.
  • ICD-10 codes can be used starting on October 1, 2015, but only for dates of service on or after October 1, 2015.

The claim will be denied.  Only one code set per claim is allowed.

Claims which span the October 1, 2015 date should follow the guidelines outlined in Provider Bulletin 15-22.

Dual processing, or native processing, means claims with ICD-9 codes will be processed as ICD-9s and claims with ICD-10 codes will be processed as ICD-10s.  Nebraska Medicaid will not translate or map any ICD code a provider submits.

No, unspecified codes will continue.  Please consider the following in regard to unspecified code usage.

  • 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 suspended for additional documentation.

Claims for dates of service prior to October 1, 2015, must be submitted with ICD-9 codes, regardless of the date submitted. Please note:

  • The Nebraska Medicaid claim filing deadline changed effective September 1, 2013, from within one (1) year to six (6) months from the date of service. See Provider Bulletin #13-50 for details.
  • A provider should also factor in how long he/she needs to be able to report ICD-9 for claim adjustments. Claim adjustments are allowed up to 90 days from the payment date of the Remittance Advice.  There are also exceptions to the 6 month timely filing rule, which can be found in 471 NAC 3-002.01A at Payment for Medicaid Services.

The claim submission timeframe has changed to six (6) months after the date of service.  This requirement began for claims with dates of service September 1, 2013 or later. See Provider Bulletin #13-50 for details.  There are also exceptions to the 6 month timely filing rule, which can be found in 471 NAC 3-002.01A at Payment for Medicaid Services.

Nebraska Medicaid adopted the new CMS 1500 professional paper claim form on April 1, 2014. Nebraska Medicaid accepts and processes 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 have been returned to the provider. See the Provider Bulletin #13-75 for additional information.

DELAY

Please send delay-related questions directly to the ICD-10 mailbox at:
DHHS.ICD-10Implementation@nebraska.gov 

MENTAL HEALTH PROVIDERS

Yes. Nebraska Medicaid currently requires ICD-9 diagnosis codes for dates of service prior to the implementation of ICD-10. While DSM-IV codes were designed to correspond with ICD-9 codes, they do not correspond to ICD-10 codes. Mental health providers must transition to ICD-10 in order to have claims considered for payment for dates of service on or after October 1, 2015.

ICD-10 codes must be submitted for dates of service on or after October 1, 2015. 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, 2015. 

PROVIDER READINESS

All covered entities under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 must implement the new code sets by October 1, 2015.  Covered entities required to use the new code sets include health plans, private and government payers, providers, clearinghouses, healthcare information system vendors, billing agents and other services.

ICD-10 will affect diagnosis and inpatient procedure coding for all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.  Examples of covered entities include hospitals, physician practices, health plans, etc.

After October 1, 2015, without ICD-10 diagnosis coding, providers may experience:

  • Delayed payments or even non-payment,
  •  Increased rejected, denied or suspended claims,
  • Reduced cash flow,
  • Potential lost revenue.

Payments to providers cannot be made without the proper ICD-10 coding.

No. The Federal mandate applies to all claims, whether submitted electronically or on paper. There is no exception for paper claims.

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 transitioning to ICD-10.

The Centers for Medicare & Medicaid (CMS) provides extensive information, fact sheets, tools, and resources for providers, vendors and payers for implementing ICD-10.  Here are select links to assist you with your ICD-10 efforts.  For more information, visit the CMS website at www.cms.gov/icd10.

  • CMS’s Road to 10: The Small Physician Practice's Route to ICD-10.
  • Check out the ICD-10 Quick Start Guide for a 5 step checklist to help health care professionals get ready.
  • See  Provider Bulletin 15-23 for details on electronic and paper claims testing with Nebraska Medicaid.

RESOURCES
  1. Where can we find resources for assistance in preparing for ICD-10 implementation?

Nebraska resources

National resources

ICD-10 Code books order now. Nebraska Medicaid cannot supply the code books or recommend a publisher.

TESTING

Nebraska Medicaid began testing ICD-10 electronic transactions with Trading Partners on April 1, 2014. See Provider Bulletin #15-23 for details on electronic and paper claims testing with Nebraska Medicaid.

Contact your Trading Partner/Clearinghouse and let them know you would like to test with NE Medicaid. To register for testing, have your Trading Partner contact the Nebraska Medicaid EDI Help Desk at 866-498-4357 or 402-471-9461 (Lincoln) or DHHS.MedicaidEDI@nebraska.gov.  See Provider Bulletin #15-23 for details on how to test electronic claims with Nebraska Medicaid.

Nebraska Medicaid began testing ICD-10 electronic transactions with Trading Partners on April 1, 2014. See Provider Bulletin #15-23 for details on electronic and paper claims testing with Nebraska Medicaid.  While testing is not required, it is highly recommended to ensure accurate and prompt payment of Fee-For-Service claims after October 1, 2015.

Yes, both ICD-9 and ICD-10 coded claims should be included in the same file during testing following these testing rules:

  • Use 04/01/2015, instead of 10/01/15, as the ICD-10 test implementation date.
  • ICD-9 will be accepted only with dates of service prior to 04-01-2015.
  • ICD-10 will be accepted only with “to” or “discharge” dates of service on or after 04-01-2015.
  • ICD-9 and ICD-10 will not be accepted on the same claim.
  • Practitioner claims with dates of service that span the implementation date should be split into two claims. This means that ICD-9 codes with dates of service prior to 04-01-2015 are on one claim and ICD-10 codes with dates of service on 04-01-2015 or later are on the other.
  • ICD-10 codes should be submitted without the decimal, just as ICD-9 is submitted today.
  • All claims must contain the appropriate ICD indicator. Providers should contact their billing and/or software vendor to ensure their system is able to send either the ICD-9 or ICD-10 indicator as appropriate.  MMIS currently rejects electronic claims if the indicator is not submitted.

See Provider Bulletin #15-23 for details on how to test electronic claims with Nebraska Medicaid.

Yes, providers can submit paper claims for ICD-10 testing. See Provider Bulletin #15-23 for details on how to test paper claims with Nebraska Medicaid.  While testing is not required, it is highly recommended to ensure accurate and prompt payment of Fee-For-Service claims after October 1, 2015.

No. Only ICD-10 codes will be accepted during testing following these testing rules:

  • Use 04/01/2015, instead of 10/01/15, as the ICD-10 test implementation date.
  • The ICD indicator box must be marked appropriately on all claims (e.g. “0” for ICD-10). Claims without the indicator will be rejected and fail testing.
  • Test claims submitted with an ICD-9 indicator and/or ICD-9 codes will be rejected.

See Provider Bulletin #15-23 for details on how to test paper claims with Nebraska Medicaid.

Paper test claims for ICD-10 testing must be submitted via secure email as an attachment to DHHS.MedicaidICD10PaperClaimsTesting@Nebraska.gov or secure fax at 402-742-1135.  See Provider Bulletin #15-23 for details on how to test paper claims with Nebraska Medicaid.

No. Paper test claims for ICD-10 testing must be submitted via secure email as an attachment to DHHS.MedicaidICD10PaperClaimsTesting@Nebraska.gov or secure fax at 402-742-1135.  See Provider Bulletin #15-23 for details on how to test paper claims with Nebraska Medicaid.

  • See Provider Bulletin #15-23 for details on how to test electronic and paper claims with Nebraska Medicaid.
  • For testing purposes only, use 04/01/15 as the ICD-10 test implementation date. Future dates of service cannot be tested by Nebraska Medicaid.
  • Real data is required on test claims (e.g. current eligible Medicaid IDs, active Medicaid Provider NPI, Taxonomy and Zip Code +4, etc.)
  • Production claims that have successfully been processed by Nebraska Medicaid would be good claims to re-code with ICD-10 for testing as resulting errors are more likely to relate to ICD code testing. This will also allow the State to compare test results with the originally processed claims to ensure consistency in edit and payment logic.
  • Build a diverse grouping of claims to be used for comparison in testing.
  • Evaluate the completeness of clinical documentation to ensure that a specific ICD-10 code can be identified and supported by the documentation.
  • Have coders practice entering ICD-10 codes as a way to identify any training needs.
  • Please work with your billing staff, office management software vendor, IT staff and clearinghouse, as appropriate, to ensure readiness for testing.

TRADING PARTNER / CLEARINGHOUSE / SOFTWARE VENDOR / THIRD PARTY BILLING

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 with the transition to help your customers be ICD-10 compliant on or before October 1, 2015.

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.

It is important to know that while Trading Partners/Clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder. The ICD-10 code(s) selected should be based on a medical encounter and clinical documentation.

For ICD-10, Trading Partners/Clearinghouses can help by:

  • Identifying problems that lead to claims being rejected
  • Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

As providers prepare for the October 1, 2015, ICD-10 deadline, Trading Partners/Clearinghouses are  good resources for testing to be sure that their ICD-10 claims can be processed—and for identifying and helping to remedy problems found in their test ICD-10 claims.

MLTC has encouraged clearinghouses and Trading Partners to test on behalf of their providers.  We encourage providers to reach out again to their clearinghouse or Trading Partner to request that they coordinate a test run with Medicaid.  Providers should explain that they want to ensure their claim submissions can be accepted on October 1, 2015.

While testing is not required, it is highly recommended to ensure accurate and prompt payment of Fee-For-Service claims after October 1, 2015.

Nebraska Medicaid began ICD-10 electronic transaction testing with Trading Partners April 1, 2014. See Provider Bulletin #15-23 for details on how to test electronic claims with Nebraska Medicaid.

QUESTIONS?

Contact the ICD-10 mailbox at DHHS.ICD-10Implementation@nebraska.gov

Vendors

Talk to Your Customers

  • Talk to your customers about your implementation plans to ensure that their ICD-10 transition goes smoothly and on schedule.
  • Allow adequate time for customers to conduct rigorous internal and external testing of your products.
  • Coordinate implementation timelines based on your customers’ needs, and establish a comprehensive approach that will deliver compatible products.
  • Explain how system upgrades/replacements accommodate ICD-10.
  • Discuss costs involved and whether upgrades will be covered by existing contracts.
  • Identify when upgrades or new systems will be available for testing and implementation.
  • Review the customer support and training that you will provide.

Explain to your customers how your products will accommodate both ICD-9 and ICD-10 code sets.

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