Latest ICD-10 Update
On July 31, 2014, the U.S. Department of Health and Human Services (HHS) officially delayed the transition of the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) to the 10th Edition (ICD-10-CM) and the adoption of the inpatient hospital procedure coding standards known as ICD-10-PCS (collectively referred to as ICD-10) from October 1, 2014, to October 1, 2015. ICD-10-PCS requires that all covered entities use ICD-10 codes on claims and other health care transactions submitted for dates of service on or after October 1, 2015, and for inpatient services with dates of discharge on or after October 1, 2015.
MassHealth continues to test with its trading partners and is actively contacting providers and vendors to schedule test dates. If you are interested in testing your ICD-10 transactions with MassHealth, please contact the MassHealth EDI testing team toll-free at 1-855-295-4047 or by e-mail at email@example.com. (For previous updates listed under Provider Information, click here)
On January 16, 2009, HHS published a final rule on the International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS), requiring all HIPAA-covered entities to adopt the ICD-10-CM/PCS (diagnosis/inpatient procedure codes) by October 1, 2013. Because of industry readiness concerns, the final rule was modified on September 5, 2012, to delay the adoption of the code set until October 1, 2014.
Subsequently, the Protecting Access to Medicare Act of 2014 (H.R. 4302) mandated that HHS cannot adopt the ICD-10 code set as the standard before October 1, 2015. HHS is expected to officially announce a new ICD-10 implementation date.
Effective for dates of service on or after the ICD-10 implementation date, claims submitted to MassHealth must include the ICD-10 diagnosis codes. In addition, claims for inpatient services with a date of discharge on or after the implementation date must be billed with the new ICD-10 diagnosis and inpatient procedure code set.
The following table displays the high-level differences between ICD-9 and ICD-10, and PCS codes.
|Diagnosis (CM)||13,000 codes||68,000 codes|
|3-5 Digits (Numeric)||3-7 Alphanumeric characters|
|Inpatient Procedure Coding System (PCS)||3,000 codes||72,081 codes|
|3-4 Digits (Numeric)||7 Alphanumeric characters|
Please Note: While the new ICD-10 codes will provide greater specificity through the expansion of the overall code set, providers will need to adopt only those codes that are relevant to their day-to-day operations.
The MassHealth ICD-10 web page will be used to communicate key information to providers related to the ICD-10 implementation. Providers should continue to monitor this page to view important MassHealth ICD-10 information as it becomes available.
Please refer to the links below for more information about ICD-10 implementation standards.
Billing Guides for Paper Claims Submitters
MassHealth has updated the following billing guides to support ICD-10 implementation.
- CMS-1500 Billing Guide
- UB-04 Billing Guide (ICD-10 DRAFT)
- Residential Care Home Billing Guide for the UB-04 (ICD-10 DRAFT)
- Changes to CMS-1500 and UB-04 Billing Guides (ICD-10 DRAFT)
MassHealth has made draft changes to select provider manuals to support ICD-10 implementation.
MassHealth has updated the following forms to align with ICD-10 implementation.
- MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Therapeutic Shoes, Inserts, and Modifications [ORT-D (Draft 04/14)]
MassHealth has updated the following job aids to support the implementation of ICD-10.
- MMIS POSC Job Aid: Institutional Claims Submission with MassHealth
- NewMMIS Job Aid: Professional Claim Submission with MassHealth
- NewMMIS Job Aid: Submit a Residential Care Home Claim
- NewMMIS Job Aid: Submit MMQ
Payment and Coverage Guideline Tools
MassHealth has updated the following tools to support the implementation of ICD-10
- MassHealth DME and Oxygen Payment and Coverage Guidelines Tool file size 2MB file size 1MB
MassHealth Provider bulletins issued to support the implementation of ICD-10.
All Provider Bulletin 249: ICD-10 Implementation Readiness
- All Provider Bulletin 248: Information about ICD-10
- All Provider Bulletin 241: Information about ICD-10-CM/PCS
- All Provider Bulletin 228: Information about ICD-10-CM/PCS
MassHealth is committed to providing ICD-10 information and educational materials to the provider community to support the implementation of ICD-10.
- ICD-10 Provider FAQs
- ICD-10 EDI Frequently Asked Questions
- ICD-10 Key Concepts
- ICD-10 EOB Edits
- MassHealth ICD-10 Implementation Presentation
- MassHealth ICD-10 Vendor Testing
- Most Common ICD-10 Trading Partner File Submission Errors
- Tips for Submitting ICD-10 Test Files to MassHealth
- Centers for Medicare & Medicaid Services (CMS) Implementation widget - Outlines the steps to take to transition to ICD-10 - www.cms.gov/ICD10/
- Workgroup for Electronic Data Interchange (WEDI) - http://www.wedi.org/topics/icd-10
This information is provided by MassHealth.