Nebraska Medicaid Program

ICD-10 Implementation Project

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ICD-10 implementation is here!  Nebraska Medicaid continues to successfully pay claims with ICD-10 codes!

  • NEW Click on: YouTube Video IconICD-10 video to view a discussion of the unique characteristics and features of the ICD-10 coding system. This educational video from CMS is 33 minutes long.
  • Nebraska Medicaid is ready to accept and process ICD-10 codes effective October 1, 2015.
    • Note: Nebraska Medicaid claims can be submitted for up to 6 months from the date of service.
    • ICD-9 will only be accepted for processing if the dates of service are before 10-1-2015.
    • ICD-10 will only be accepted for processing if the dates of service (“to” date or discharge date) are on or after 10-1-2015.
  • Questions?  Email us at: DHHS.ICD-10Implementation@nebraska.gov
 
Notifications:

The following Provider Bulletins have been published regarding ICD-10 Implementation.

Recently published Provider Bulletins:

The following provider bulletins were published in 2015:

Previously published Provider Bulletins:

NEW Recent Developments 

  •  Go to: YouTube Video IconICD-10 video to view a discussion of the unique characteristics and features of the ICD-10 coding system. This educational video from CMS is 33 minutes long.

Communication

  • For questions specific to the ICD-10 transition, contact the ICD-10 Team at:  DHHS.ICD-10Implementation@nebraska.gov
  • RECEIVE EMAILED UPDATES:  Please subscribe above to this ICD-10 webpage to receive notice of updates as further information is available.

Information about the International Classification of Diseases, 10th Revision (ICD-10)

    The United States Department of Health and Human Services requires that all HIPAA covered entities use ICD-10 codes beginning October 1, 2015.  The ICD-10 coding system will fully replace the ICD-9 coding system and have a substantial impact on the entire health care industry.

    The ICD-10 final rule concurrently adopts 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.

    As a HIPAA covered entity, Nebraska Medicaid has transitioned to ICD-10 for both electronic transactions and paper claims effective October 1, 2015.  The Medicaid Management Information System (MMIS) has been remediated to accept and process with ICD-10 codes effective October 1, 2015, for dates of service on or after October 1, 2015.

    Highlights of how claims will be impacted when ICD-10 is implemented October 1, 2015

    • Reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers.
    • Providers must submit claims with either ICD-9 or ICD-10 codes and matching ICD indicator depending on the date(s) of service:
      • Claims for dates of service prior to October 1, 2015, must be submitted with ICD-9 codes and an ICD-9 indicator, regardless of the date submitted.

      • Claims for dates of service on or after October 1, 2015, must be submitted with ICD-10 codes and an ICD-10 indicator.

      • Refer to Provider Bulletin 15-22 to determine which ICD code and matching indicator to use for claim types where the dates of service begin before but end after October 1, 2015.

    • Electronic and paper claims combining both ICD-9 and ICD-10 codes will be rejected, regardless of the date of service.
    • Dental Claims (paper and electronic 837D) will not require ICD-10 diagnosis codes.  Claims will not be rejected if a valid diagnosis code(s) is submitted.
    • Electronic and paper claims will be processed using the same rules for diagnosis coding.
    • On or after 10-1-2015, Providers must use either ICD-9 or ICD-10 based on the date(s) of services claimed, regardless of the billing date.
    • Providers must submit claims within180 days (6 months) after the date of service.

    Test Plan

    Providers and Trading Partners should now use 10/01/15 as the ICD-10 test implementation date on all paper and electronic ICD-10 test claims.

    Provider Bulletin 15-23 details updates to the ICD-10 testing plan, including the addition of paper claims testing.
    While testing is not required, it is highly recommended to ensure accurate and prompt payment of Fee-For-Service claims after October 1, 2015.

    Frequently Asked Questions (FAQs)

     

    Resources

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

    NEW ICD-10 Post-Implementation: Coding Basics Revisited MLN Connects® Video: Check out this Centers for Medicare & Medicaid Services (CMS)YouTube Video Icon ICD-10 video discussion of the unique characteristics and features of the ICD-10 coding system. Run time: 33 minutes.

    Topics include:

    • What is a valid code
    • Guidelines for coding and reporting
    • Coding process and examples: 7th character, unspecified codes, external cause codes, laterality
    • How to submit coding questions
    • Resources for coders

    CMS’s Road to 10: The Small Physician Practice's Route to ICD-10.  Roadto10.org is your one-stop source for all things ICD-10. This site is for the small physician practice. This interactive site includes FAQs, Specialty References, Template Library and more.

    Check out the ICD-10 Quick Start Guide for a 5 step checklist to help health care professionals get ready.

    CMS ICD-10 Code Sets:  The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge.

    45 CFR Part 162, Final Rule : Governing legislation for implementing the ICD-10 code sets.

    CMS Provider Resources:  Resources to assist providers in the transition to ICD-10

    CMS Vendor Resources:  Resources to assist vendors in the transition to ICD-10

    CMS 2014 ICD-10-CM and GEMs and CMS 2014 ICD-10 PCS and GEMs:  GEMs are General Equivalence Mappings between ICD-10-CM and PCS and ICD-9-CM codes.  They are designed to assist converting applications and systems from ICD-9 and ICD-10 codes and are updated annually.

    Check out the Nebraska Health Information Management Association website at:  http://www.nhima.org for some training opportunities in Nebraska.

    Nebraska ICD-Collaborative is the website of Nebraska individuals and organizations working together to facilitate communication, collaboration and information sharing.  It includes resources and events. 

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