Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth All Provider Bulletin 241 January 2014 TO: All Providers Participating in MassHealth FROM: Kristin L. Thorn, Medicaid Director RE: Information about ICD-10-CM/PCS Background On January 16, 2009, the U.S. Department of Health and Human Services (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 ICD10- CM/PCS (diagnosis/inpatient procedure codes). Effective October 1, 2014, claims submitted to MassHealth must include ICD-10 diagnosis codes. In addition, claims for inpatient services with a date of discharge on or after October 1, 2014, must contain the new ICD-10 inpatient procedure code set. MassHealth Status MassHealth is currently remediating the MMIS, and relevant databases to support ICD-10. Additionally, all of the documentation used to support policy and billing are being evaluated to determine if any modifications are needed to accommodate the new ICD-10 code set. Once the evaluation is complete, MassHealth will determine when the documentation will be modified and made available to providers. Key Concepts The ICD-10 code set has introduced a number of key concepts (e.g., detailed description of body parts and laterality), nomenclature changes (e.g., definition of trimester), and expanded codes (e.g., injury and diabetes). MassHealth is currently evaluating how these key concepts impact MassHealth billing and policy documentation. Once the evaluation is complete MassHealth will outline if and how these key concepts will be addressed. Trading Partner Testing MassHealth anticipates that it will initiate trading partner testing in the second quarter of 2014. It is important that the early phase of testing (“beta testing”) include a variety of provider types of both large and small organizations to ensure that a wide range of test scenarios is received during this phase. It is equally important that providers submit true ICD-10 coded claims, as this will enable MassHealth to anticipate the type of codes that could be encountered during standard trading partner testing (continued on next page) MassHealth All Provider Bulletin 241 January 2014 Page 2 Trading Partner Testing (continued) and in the production environment. Further details on the testing timeline, requirements, and instructions will be made available before the testing phase. If you are interested in participating in beta testing with MassHealth, please contact MassHealth Customer Service at 1-800-841-2900. Prepare for Implementation It is important that providers prepare for the MassHealth implementation of ICD-10. MassHealth will continue to provide guidance and direction related to specific MassHealth changes. At a minimum, providers should take the following actions. . Monitor MassHealth communications about ICD-10 implementation at www.mass.gov/masshealth/icd-10. This page will contain the most up-to-date information about ICD-10 implementation by MassHealth. . Confer with all applicable third-party vendors and organizations that support components of your ICD-10 solution to ensure coordination and readiness. . Practice coding ICD-10 claims within your organization to ensure that business operations are aligned and content is available to support testing. . Remediate systems (as applicable) and prepare them for testing. . Prepare testing, implementation, operational readiness, and training plans. . Prepare contingency plans. ICD-10 Provider Readiness Survey MassHealth is very interested in understanding the status of your implementation activities and has developed a provider readiness survey. Please complete the ICD-10 Provider Readiness Survey at the MassHealth website no later than January 31, 2014. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.