On January 16, 2009, the final rule was published requiring all HIPAA covered entities to adopt the ICD-10 code sets in replacement of the ICD-9 code sets. April 17, 2012 the United States Department of Health and Human Services (HHS) published a proposed rule that would delay the compliance date from October 1, 2013 to October 1, 2014 for the ICD-10 code set implementation. On August 24, 2012 HHS announced a final rule accepting the one-year proposed delay. The compliance date is officially October 1, 2014. Click here for the HHS News Release.
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, 2014.
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, 2014.
Additional Links for ICD-10 Information
MDCH Implementation Approach
MDCH 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, MDCH 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, MDCH 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, 2014 will need to use ICD-10 codes. Due to timely filing rules/standards both code sets will be used simultaneously for some time.
MDCH'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.
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, MDCH is providing a search tool to assist in navigation and for viewing the CMS GEMs.
2014 ICD-10-CM and GEMs
2014 ICD-10-PCS and GEMs
2013 ICD-10-CM and GEMs
2013 ICD-10-PCS and GEMs
Blue Cross Blue Shield
ICD-10 Code Translator
MDCH is performing both Internal and External End-to-End (E2E) testing of its systems and procedures impacted by migration to ICD-10, in order to ensure those systems meet the State's information requirements without unexpected financial or operational impact on the State, its providers or trading partners.
Our Internal E2E Testing includes a broad range of testing activities including developer testing, unit testing, integrated system testing and user acceptance testing. Internal testing timelines vary from system to system, but in general we plan to complete our Internal E2E Testing activities for all impacted systems by December 31, 2013.
External E2E Testing activities are being conducted with those business partners, trading partners and providers who communicate with MDCH using ICD-coded transactions. For our Business Partners (who perform services under contract to MDCH), we will initially focus on monitoring their system remediation activities. This is being performed to ensure their systems and procedures will properly support operations under ICD-10. This monitoring activity is currently in process and will continue through October 1, 2014, the ICD-10 compliance date.
We are providing multiple opportunities for our providers and trading partners to conduct testing with MDCH. These major testing phases include:
- Outpatient Scenario-based Testing - MDCH has created a survey-based tool that allows providers of selected medical specialties to review common outpatient scenarios and assign the ICD-10 diagnosis codes that they feel apply. Each provider will then receive feedback on how their coding choices compared to the other providers who took the survey. Click here 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.
- Inpatient Comparative Testing - MDCH is performing comparative testing of inpatient claims with selected inpatient hospitals and facility providers. For these providers, we are selecting a small sample set of claims that have been submitted to CHAMPS using ICD-9 codes and asking those organizations to review their medical records and recode those selected claims using ICD-10 codes, as if the service had been provided after the compliance date. These recoded claims are then being analyzed to look for changes in DRG assignment and/or adjudication results.
- Business-to-Business Testing - Trading Partners and Providers will be encouraged to test claim adjudication and encounter processing functions using the CHAMPS B2B Test environment (hosting an ICD-10 compliant test version of CHAMPS). We will provide claim processing adjudication reporting, encounter processing reports and 835 remittance advice transactions to our Trading Partners, for their review and testing functions. This will enable Trading Partners to determine whether their remediated systems can produce and process those transactions.
Trading Partners will be able to submit test files to the B2B Test System through:
1) The State's Data Exchange Gateway (DEG)
2) Direct upload of EDI transactions using CHAMPS web-batch upload functionality
3) Web-enabled Direct Data Entry (DDE) submission, or
4) On-line claim adjustment processing.
The B2B Test System will validate that ICD-10 coded transactions process and generate appropriate CHAMPS response transactions, which the Trading Partner may use to confirm that response files process in their internal systems. Trading Partners will be requested to test using the native ICD-10 Diagnosis and Procedure codes they plan to submit following the ICD-10 compliance date of October 1, 2014.
We will offer all providers and trading partners an opportunity to perform B2B Testing in January 2014.
ICD-10 B2B Testing Instructions Coming Soon
Outpatient Scenario-Based Testing
MDCH has created a survey-based tool 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 survey.
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 MDCH. 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 have created six scenarios for each of the eleven specialty areas listed above. We encourage interested providers to participate in as many specialty areas that apply to their operation.
Before completing the survey, which in effect is a coding exercise, we encourage our providers to review the scenarios, to assess the specialty areas of interest and assemble supporting materials to assist in the coding exercise. This can be done by clicking on the specialty area listed above.
Our survey provides two tracks - one option for coders and billers and a second option for physicians, nurse practitioners or physician assistants. The difference between the two tracks is that the track for physicians, nurse practitioners or physician assistants omits narratives for disposition, clinical impression, and/or assessment and plan; narratives that include these topics are included in the coder or biller track.
For each of the six scenarios in each of the eleven specialty areas, providers are asked to review the scenario as documented and assign from one to eight ICD-10-CM (diagnosis) codes that best describe the hypothetical situation. Once a provider has completed the survey for the six scenarios in a specialty area, the provider may either note their responses as complete and end the survey, or loop back, choose another specialty area, and assign ICD-10-CM (diagnosis) codes for six scenarios in a different specialty area.
Follow this link to access and complete the survey:
As responses are received, we will compile the responses received for each scenario and provide providers with a summary comparative report by email. Note that MDCH is not grading the survey responses in any way or attempting to provide the "correct" answers.
We will provide all participants with a summary report 1-2 business days after they complete the survey, comparing their coding choices to the choices made by other providers who have taken the survey. That response will be emailed to the respondent, using the email address provided on the first page of the survey. We will also post summary results for each scenario, for each specialty area.
Summary results Coming Soon
Other MDCH links and related sources
ASC X2 TR3s and MDCH Companion Guides
HIPAA 5010 Transaction Testing
Electronic Submitter Manual