Learn how DMAP plans to convert Oregon Medicaid systems and policies from ICD-9 to ICD-10.
Congress recently passed the Protecting Access to Medicare Act of 2014 (HR 4302), which reads as follows:
“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for codes sets under section 1173 (c) of the Social Security Act (42 U.S.C. 1320d-2 (c)) and section 162.1002 of title 45, Code of Federal Regulations.”
Updates from CMS
We will post updates as more information about the delay and new implementation timelines are made available.
On May 20, 2014, CMS announced an extension of the partial code freeze:
"The ICD-9-CM Coordination and Maintenance Committee implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10, which would end one year after the implementation of ICD-10. On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.
"The partial code freeze will continue through October 1, 2015, the new planned implementation date. Regular updates to ICD-10 will begin on October 1, 2016, one year after the implementation of ICD-10. See Partial Code Freeze for ICD-9-CM and ICD-10 for more information.
"The 2015 ICD-10-CM and 2015 ICD-10-PCS files are now posted on the CMS website at 2015 ICD-10-CM and 2015 ICD-10-PCS. The 2015 General Equivalence Mappings (GEMs) will be posted later this summer."
On May 5, 2014, CMS released the following statement regarding an ICD-10 implementation deadline of October 1, 2015:
“On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”
Also see our full resource list.
Questions and answers
If you have questions not answered on this page, visit the Centers for Medicare and Medicaid Services (CMS) and Workgroup for Electronic Data Interchange (WEDI) websites. You can also email the ICD-10 Project Team.
|What is ICD-10?|ICD-10 is the 10th edition of the International Classification of Diseases Clinical Modification/Procedure Coding System. ICD-10 expands the number of codes from 18,000 ICD-9 codes to more than 140,000 ICD-10 codes. This quick reference explains the similarities and differences between the two coding systems. Once ICD-10 is implemented:
More detailed coding is helpful and brings the United States in line with non-U.S. practices. The ICD-10 codes allow for more accurate information to accompany a claim, which will allow for more accurate claims payment and coverage decisions.
- ICD-10 diagnosis codes must be used for all health care services.
- ICD-10 procedure codes must be used for all hospital in-patient procedures.
|Who does ICD-10 affect? |
ICD-10 affects all health care entities (including providers, plans and clearinghouses) that use ICD-9 codes for medical coding or processing of health care transactions (e.g., claims).
We are evaluating the potential impact of ICD-10 on provider reimbursement, contracting and clinical operations. ICD-10 conversion was not intended to transform payment or reimbursement. However, it may result in reimbursement methodologies that more accurately reflect patient status and care.
- Once implemented, ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after the implementation date. Otherwise, your claims and other transactions will be rejected, and you will need to resubmit them with the ICD-10 codes.
- This will impact your reimbursements, so it is important to start preparing for the changeover to ICD-10 codes.
- This change does not affect CPT coding for outpatient procedures.
|What do providers need to do?|Don't delay: The ICD-10 compliance date may seem far off, but the complexity of conversion requires immediate action. ICD-10 conversion will affect nearly all provider systems and many processes.
For more information to help you prepare, visit the CMS ICD-10 Provider Resources page
- Identify and plan for the ways ICD-10 will change how you do business with all payers, including DMAP. The largest impacts will likely be in clinical and financial documentation, billing and coding.
- Contact your billing or software vendor and let them know your business needs and implementation schedule. Ask questions to understand their plans for conversion and testing.
|What is DMAP doing?|
Code set mapping: DMAP has developed an ICD-10 master equivalence map that includes all existing ICD-9 and ICD-10 codes. This map is a general reference map only; it is not intended to be used as an ICD-10 conversion or crosswalk tool. DMAP expects to release a second, more specific map to remediate our internal business and policy processes in Fall 2013.
Business and systems preparation: We have completed system requirements to accommodate ICD-10 and are now working on system development, business process remediation, and policy remediation.
Testing: We started internal system testing in April 2013. Once we complete internal testing, we will begin parallel testing with selected trading partners for external (business-to-business) testing. We expect to begin external testing in early 2014.
Communications: We will keep providers informed about our progress on the ICD-10 conversion, including timelines and testing.
Contingency planning: DMAP does not plan to support ICD-9 codes for dates of service after the ICD-10 compliance date. However, we will continue to closely follow communications from CMS and adapt our approach as permitted.
|What does the Protecting Access to Medicare Act mean for providers?|
DMAP will not be able to accept transactions using ICD-10 until at least 10/1/2015. We will continue to work on the transition to ICD-10.
The federal agency, Centers for Medicare and Medicaid Services, is examining the federal legislation and will provide guidance soon. We will post updates to this webpage as more information about the delay and new implementation timelines are made available.