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Oregon Health Plan

ICD-10 Implementation

DAYS 472
HOURS 23
MINS 53
SEC 48

Learn how DMAP plans to convert Oregon Medicaid systems and policies from ICD-9 to ICD-10.


Resources and updates​

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.

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Answer
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:

  • 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.

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.

    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).

    • 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 October 1, 2014. 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.
    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.
    What is DMAP doing?

    We plan to meet all related timeframes for compliance. We expect providers and clearinghouses that we work with will also meet those timeframes. Our current areas of focus are:

    • Code set mapping: CMS has provided General Equivalence Mappings (GEMs) as an approach to define reasonable alternatives for mappings between ICD-9 and ICD-10 codes in both directions. We will only use the GEMs and other mapping tools to map our internal business and policy remediation processes.
    • 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.
    • 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 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.

    • 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.
    For more information to help you prepare, visit the CMS ICD-10 Provider Resources page.
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    Provider Readiness Survey

    Please complete our readiness survey to tell us about your progress in preparing to meet the ICD-10 compliance date of Oct. 1, 2014. Your confidential response to this survey will help us improve DMAP's outreach efforts for ICD-10 compliance.

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