HIPAA ICD-10 Implementation

 

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 beneficiariy'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 Community Health is working to prepare ourselves and our providers for implementation on October 1, 2015.


 
MDHHS Links

ICD10 Implementation Button

ICD10 A&T Button

ICD10 Testing Button

 ICD10 GEMs Button

 

ICD10 Contact Us Button 

 


  

Additional Links for ICD-10 Information

CMS ICD-10

Workgroup for Electronic Data Interchange (WEDI)

AHIMA

Blue Cross Blue Shield of Michigan (BCBSM)

Healthcare Information and Management System (HIMSS) ICD-10 Playbook

American Medical Association (AMA)

*New Coding Tool:  ICD-10 Code Lookup by NueMD

 

 

MDHHS Implementation Approach

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.

 


  

Awareness & Training

The Michigan Department of Health and Human Services 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?

Training Sessions - currently covering ICD-10 Basics and Provider Impacts.

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. 

Webcasts

 ICD-10 Implementation: "Get Ready"

 Silverlight Media Player Users 

 Classic Media Player Users 

 ICD-10 "Provider Impacts Webcast" 
 ICD-10 Provider Readiness ICD-10 Clinical Documentation

Documents

What Everyone Should Know About ICD-10 

MDHHS CMS Frequently Asked Questions

ICD-10 Where do I start? 

MDHHS Specific ICD-10 Frequently Asked Questions 

What Everyone Should Know About ICD-10's New Compliance Deadline

ICD-10-CM and ICD-10-PCS Myths and Facts

Provider Readiness Development Course

ICD-10 Provider Preparations

ICD-10 Updates 

 

May 2015 

June 2015 

July 2015 

 

 


 

General Equivalence Mappings (GEMs)

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 all three 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.

For ease of use, MDHHS is providing a search tool to assist in navigation and for viewing the CMS GEMs.

     GEM Viewer

CMS GEMs

     2016 ICD-10-PCS and GEMs

     2016 ICD-10-CM and GEMs

 AAPC

     ICD-10 Code Translator

 

ICD-10 Testing

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:

  1. Outpatient Scenario-based Testing - MDHHS has created a coding exercise that allows providers of selected medical specialties to review common outpatient scenarios and assign the ICD-10 diagnosis codes they think apply. Each provider will then receive feedback on how their coding choices compared to the other providers who took the survey. See below for additional information regarding this testing activity, including testing instructions, a link to the survey (which includes a coder/biller version) and a recap of the process used for reporting survey results.
  2. Inpatient DRG Comparative Testing - MDHHS is performing comparative testing (ICD-9 vs. ICD-10) of inpatient claims with inpatient hospitals and facility providers. MDHHS identified ICD-9 claims in CHAMPS, and these organizations are reviewing their medical records in order to recode those claims using ICD-10. Recoded claims are then analyzed for impact on DRG assignment and revenue neutrality. Please email us (at: MDCH-B2B-Testing@michigan.gov) if you wish to participate in this testing.
  3. Business-to-Business (B2B) Testing – MDHHS encourages Trading Partners and Providers to test claim adjudication and encounter processing functions using the CHAMPS ICD-10 B2B Test System. We provide claim adjudication reports, encounter processing reports and 835 remittance advice transactions for Trading Partner review and testing functions.

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

Overview

MDHHS has created a coding exercise that allows providers of selected outpatient services to review common outpatient scenarios, assign ICD-10-CM (diagnosis) codes that they feel apply to the scenario as described, and then compare their coding decisions to codes assigned by other providers who have responded to our coding exercise. Your individual coding decisions will not be shared with others and will only be used for comparison purposes in the aggregate.

These outpatient scenarios are available for the following eleven provider specialty areas:
 


Participating in this Scenario-based testing allows our providers to assess whether their clinical systems and procedures provide for adequate data collection to support accurate ICD-10 coding for typical claims scenarios reported to MDHHS. This Scenario-based testing does not require our providers to have fully remediated systems available to generate test ICD-10 claims. The provider must only be capable of assigning diagnosis codes using ICD-10. We encourage interested providers to participate in as many specialty areas that apply to their operation.  


Instructions

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:  
https://www.surveymonkey.com/s/MI_Medicaid

Provider Feedback
 

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


Overview

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.

1.) Ramp Manager Testing
 

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:

1.  Trading Partners may submit test ICD-10 batch transactions generated by their ICD-10 claim system, using the regular Data Exchange Gateway (DEG) file submission procedure. Trading Partners who submit 837, 270, or 276 transaction files through the State's DEG should include a “T" (for "test") suffix in the Application-ID, as per normal testing practice. Additional information is available in the MDHHS Electronic Submissions Manual. Please refer to ICD-10 837 Test Instructions Claims v.5 – 120114 and the ICD-10 837 Test Instructions Encounters v.5 - 120114 below, for further information.

2.  Providers may access the CHAMPS ICD-10 B2B Test system using the same SSO portal they use to access the production CHAMPS system. Providers may adjust their historical transactions using ICD-10 codes with new service dates, and re-submit the adjusted claims. Please refer to the SSO Access Instructions for ICD10 B2B Test System v.2 - 072114 and the Adjusting An Institutional Claim From ICD9 to ICD10 v.2 – 120114 documents below, for further details.

 

The following reference documents will help you perform ICD-10 testing with MDHHS:
 

  1. ICD-10 837 Test Instructions Claims v.7 – 061616 - This document provides general ICD-10 B2B test instructions. Details are also provided for Trading Partners who submit Claim or Encounter files using the MDHHS Data Exchange Gateway (DEG) system.
  2. ICD-10 837 Test Instructions Encounters v.7 – 061616 - This document provides testing instructions for Billing Agents (e.g., Health Plans) who send 837 encounter transactions to MDHHS. This document includes instructions on ICD-10 testing as well as instructions to be used by prospective Billing Agents seeking approval for production encounter submission to MDHHS.
  3. MILogin Access Instructions for the B2B Test System v1– 070116 - This document explains how a Provider may request web-based access to the new “CHAMPS B2B” application test system, using the Michigan MILogin portal.

Other MDHHS links and related sources

ASC X2 TR3s and MDHHS Companion Guides 

 

Electronic Submissions Manual