The Centers for Medicare & Medicaid Services (CMS) has announced that the U.S. Department of Health and Human Services will release an interim final rule that will include a new ICD-10 compliance date of October 1, 2015. The continued use of ICD-9-CM will be required for HIPAA covered entities through September 30, 2015. MDHHS encourages providers to continue communications with software vendors, billing agents and/or service bureaus to ensure systems and procedures will support the use of ICD-10 code sets on all HIPAA transactions by the compliance date.
MDHHS continues to present Medicaid providers and trading partners with the opportunity to test their ability to communicate with MDHHS using ICD-10 coded transactions through Business-to-Business (B2B) testing. These activities are designed to help providers ensure that their remediation efforts to prepare for the ICD-10 transition have resulted in the creation of transactions that can be processed successfully. MDHHS also recommends Medicaid providers take full advantage of the increased time in order to continue ICD-10 planning and training for a successful ICD-10 transition.
We are in the process of updating the contents of this page to reflect the delay to October 1, 2015; however, the information is still valuable and can still be referred to in preparation for the implementation of the ICD-10 code sets.
Who is impacted by the change to ICD-10?
All entities using healthcare information that contains a diagnosis and/or inpatient procedure codes will be impacted, including but not limited to all providers, payers, and plans in the United States.
What is ICD-10?
ICD-10 is the 10th revision of the International Classification of Diseases used for morbidity and mortality reporting.
When is the compliance deadline?
October 1, 2015.
Where will ICD-10 impact healthcare?
Conversion to ICD-10 will impact all individuals, systems and procedures that create, record, update, process or report on health care data based on a beneficiary's medical diagnosis or based on procedures performed in an inpatient setting.
Why change to ICD-10?
ICD-9 is limited in space and in many instances uses obsolete terminology. ICD-10 structure allows for greater specificity, greater expansion and contains updated terminology necessary for current medical practices.
How can you prepare and plan for ICD-10 implementation?
Look through the links below for more information on ICD-10, how to prepare, and information on how Michigan Department of Health and Human Services is working to prepare ourselves and our providers for implementation on October 1, 2015.
Additional Links for ICD-10 Information
*New Coding Tool: ICD-10 Code Lookup by NueMD
MDHHS completed an Impact Analysis for the ICD-10 implementation which assessed the effects of transitioning from ICD-9 to ICD-10 on our policies, processes, and systems. As a result of this analysis, MDHHS was able to identify areas requiring remediation and estimate the amount of time and effort necessary to successfully implement the ICD-10 code sets.
Since there is no direct way to "crosswalk" from ICD-9 to ICD-10, MDHHS has taken a "native" approach to our implementation activities. As part of this approach, certified coders have collaborated with clinical staff to identify ICD-10 code equivalents for existing ICD-9 codes in order to facilitate remediation efforts, such as those related to systems.
There will be a cutover from the ICD-9 to ICD-10 code sets based on date of service. All claims submitted with dates of service on or after October 1, 2015 will need to use ICD-10 codes. Due to timely filing rules/standards both code sets will be used simultaneously for some time.
MDHHS's policy remediation process involves the identification, promulgation, and finalization of program policies necessary to implement ICD-10. The purpose of this activity is to ensure ICD-10 impacted policies are remediated within compliance timelines.
MDHHS has assembled an Awareness & Training team. Our goal is to enhance provider preparedness for ICD-10 implementation October 1, 2015. How do we plan on doing this?
Visit our Medicaid Provider Training Sessions page to view training sessions and to register.
Association meetings and conferences - attend association meetings and/or conferences to present ICD-10 information and MDHHS updates.
If you would like a member of our team to come to one of your association meetings or conferences please let us know by contacting us at ProviderOutreach@michigan.gov.
Resources - Select from our links below for more information about ICD-10:
|ICD-10-CM and ICD-10-PCS Myths and Facts|
|ICD-10 Provider Preparations|
Below are the web based tools from different sources regarding the General Equivalency Mappings (GEMs). These provide a foundation for translating codes from ICD-9 to ICD-10. They are NOT a crosswalk and cannot be used without manual review and clinical decision making. A user will also have to consult the ICD-9 and ICD-10 code books to ensure the full range of available codes are considered when making decisions on translation.
It is also recommended you review the tools as you may see a variance between them, proving that no single source can be used in place of manual review. A user will need an understanding of the GEMs prior to using these tools. Further information can be found on the CMS ICD-10 website listed below.
MDHHS has completed remediation of the CHAMPS system, and is providing the CHAMPS ICD-10 B2B Test system for Provider and Trading Partner use in preparation for the national ICD-10 implementation scheduled for October 1st, 2015. All testing described below is available for use. Please review the following guidelines and email us (at: MDCH-B2B-Testing@michigan.gov) when you are ready to participate in ICD-10 testing with MDHHS.
CHAMPS ICD-10 B2B Testing is already underway with Providers and Trading Partners who currently communicate with MDHHS using ICD-9 coded transactions, to ensure their system revisions meet the State's information requirements without unexpected financial or operational impact.
We are providing the following opportunities to perform ICD-10 testing with MDHHS:
The CHAMPS ICD-10 B2B Test System validates that Trading Partner ICD-10 coded transactions process correctly and generate appropriate CHAMPS response transactions. This end-to-end approach enables Trading Partners to determine whether their remediated systems can correctly produce, receive, and process ICD-10 transactions. Trading Partners should test using native ICD-10 Diagnosis and Procedure codes they plan to submit following the ICD-10 compliance date of October 1, 2015.
See below for additional information and B2B testing instructions.
Outpatient Scenario-Based Testing
These outpatient scenarios are available for the following eleven provider specialty areas:
Before completing the coding exercise, we encourage providers to review the scenarios, assess the specialty areas of interest, and assemble supporting materials to assist in the coding exercise.
Our coding exercise provides two tracks. The coder/biller track includes narratives for disposition, clinical impression, and/or assessment and plan; the second track for physician/ nurse practitioner/physician assistant omits these narratives.
Providers are asked to review the scenarios within their specialty and assign from one to eight ICD-10-CM (diagnosis) codes that best describe each scenario. Once a provider has completed the coding exercise for the six scenarios in a specialty area, the provider may either: 1) note their responses as complete and end the coding exercise; or, 2) loop back, choose another specialty area, and assign ICD-10-CM (diagnosis) codes for the six scenarios in a different specialty area.
Follow this link to access and complete the survey:
We will compile the responses received for each scenario and email providers a summary comparative report, using the email address entered by the participant on the first page of the coding exercise. MDHHS is not grading the responses in any way nor attempting to provide "correct" answers. Participants will receive the summary report 1-2 business days after they complete the coding exercise, comparing their coding choices to the choices made by other providers who have completed the coding exercise. The summary report does not identify individual responses of any other participants, only summary totals by ICD-10 code.
Business-to-Business (B2B) Testing
The CHAMPS ICD-10 B2B Test System is made available as part of Michigan's preparation for national implementation of ICD-10 Code Set usage on October 1, 2015. The Michigan Medicaid provider community may use this test system to pursue CMS Level II Compliance, to ensure: "an entity covered by HIPAA has completed end-to-end testing with each of its external trading partners and is prepared to move into production mode with the new versions of the standards by the end of that period" (from the CMS ICD-10 Implementation Guide).
All MDHHS Providers, Health Plans, Clearinghouses, and Billing Agents are encouraged to test their ability to send ICD-10 coded transactions and obtain appropriate results. Please review the following information with your transaction submission and IT team, ensure HIPAA test transactions are appropriately identified as "Test", and verify you are working in the test environment when submitting ICD-10 coded claims or encounters. Please note that the rates included in the ICD-10 B2B Test system do not reflect the actual rates that will be in force in October 2015, when we begin processing ICD-10 coded claims in CHAMPS.
B2B Testing focuses on the ability of our Providers and Trading Partners to exchange ICD-10 coded Medicaid transactions with CHAMPS. Similar to our successful approach to testing HIPAA v5010, MDHHS offers the following two types of B2B testing to allow Providers and Trading Partners the opportunity to test claim, encounter, and query transactions; and review transaction processing results in the CHAMPS ICD-10 B2B Test environment.
Trading Partners may validate their ICD-10 EDI transactions for format and syntax using Ramp Manager. Ramp Manager enables Trading Partners to verify that changes they have made in their systems to support ICD-10 have not adversely impacted their ability to send us HIPAA-compliant 837 transactions. This transaction validation through Ramp Manager is optional for existing electronic submitters, and is not a pre-requisite for subsequent CHAMPS ICD-10 B2B Testing activities.
2.) CHAMPS ICD-10 B2B Testing
MDHHS asks Providers and Trading Partners to test claim adjudication and encounter processing functions using the CHAMPS ICD-10 B2B Test environment. We provide claim adjudication reports, encounter processing reports, and 835 remittance advice transactions to our Trading Partners for use in their own ICD-10 review and testing functions. Providers and Trading Partners may test as follows:
The following reference documents will help you perform ICD-10 testing with MDHHS:
Other MDHHS links and related sources