Latest ICD-10 Update
MassHealth will begin to conduct trading partner testing (TPT) in April, 2014, with a number of beta test partners. MassHealth is also reaching out to key trading partners to schedule testing dates for vendors and providers. We encourage trading partners to contact MassHealth Customer Service at 1-855-295-4047 to schedule a test submission date. The draft ICD-10 billing instructions and companion guides have been updated to support TPT. These documents and a billing instructions change guide are available below. (For previous updates listed under Provider Information, click here)
MassHealth is very interested in understanding the status of your ICD-10 implementation activities and has developed a survey to gather information. Please complete the ICD-10 Provider Readiness Survey. The deadline for completing the survey has been extended to February 10, 2014.
On January 16, 2009, HHS published a final rule on the International Classification of Diseases, 10th Edition, 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. Due to industry readiness concerns, the final rule was modified on September 5, 2012, to delay the adoption of the code set until October 1, 2014.
Effective for dates of service on or after October 1, 2014, 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 October 1, 2014, 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 (Alpha/Numeric)||3-7 Digits (Alpha/Numeric)|
|Inpatient Procedure Coding System (PCS)||3,000 codes||72,081 codes|
|3-4 Digits (Numeric)||7 Digits (Alpha/Numeric)|
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.
Draft Billing Guides for Paper Claims Submitters
- CMS-1500 Billing Guide (ICD-10 DRAFT)
- 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 updated the following job aids to support the implementation of ICD-10.
MassHealth Provider bulletins issued to support the implementation of 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.
- 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) - www.wedi.org/index.shtml
This information is provided by MassHealth.