Provider Notice issued 12/13/13

ICD-10 Implementation and Conversion

As issued in a final rule from the U.S. Department of Health & Human Services (HHS) on January 16, 2009, ICD-10-CM (Clinical Modification - diagnoses) and ICD-10-PCS (Procedural Coding System - for inpatient procedures) will become the new coding system for delineating medical diagnoses and procedures for care management and billing purposes.   The Tenth Edition – ICD-10 – will replace ICD-9 on October 1, 2014.

ICD-10 Implementation and Conversion

The U.S. Department of Health & Human Services (HHS) released two rules that will facilitate ongoing transition to an electronic health care environment.  

The first rule replaces the ICD-9-CM code sets now used to report health care diagnosis and procedures with ICD-10 code sets.  The transition to ICD-10 is required for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA).  The Illinois Department of Healthcare and Family Services (HFS) is a HIPAA covered entity and required to comply with the HHS mandate to use ICD-10 codes effective October 1, 2014.  ICD-10 codes must be used for claims with date of service or date of discharge on or after October 1, 2014.

The second rule adopts an updated X12 standard, Version 5010, for certain electronic health care transactions.  Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions.  Version 5010 also accommodates the use of the ICD-10 codes sets, which are not supported by Version 4010/4010A1.  HFS adopted Version 5010 April 2011.

HFS ICD-10 Transition - Frequently Asked Questions:

1. When will HFS begin to accept ICD-10 claims?

    HFS will start accepting claims using ICD-10 codes on October 1, 2014 for dates of service/discharge on or after October 1, 2014.

2. How will HFS determine whether ICD-10 or ICD-9 is the appropriate code set to use? 
   
   The date of service or the date of discharge for inpatient claims will be the deciding factor in determining which codes set is appropriate.  If the date of service/discharge is before October 1, 2014, then ICD-9 codes should be used.  Any dates of service/discharge occurring on or after October 1, 2014 should use ICD-10 codes. 

3. Do you plan on converting ICD-10 codes to ICD-9 codes?
   
   HFS will not convert claims.  Based upon the date of service/discharge, a claim will be processed as either an ICD-10 or ICD-9.  Claims without the appropriate code set for the date of service/discharge will not be accepted. 

4. Will HFS still accept ICD-9 codes after October 1, 2014?
   
   Yes, the Department will still accept claims with ICD-9 codes after October 1, 2014.  However, ICD-9 codes will only be accepted for claims with dates of service/discharge before October 1, 2014.  Any dates of service/discharge after September 30, 2014 must use ICD-10.

5. Will we be able to submit an ICD-9 claim with a date of service/discharge later than October 1, 2014? 
   
   No, any claim with an ICD-9 code submitted for a date of service/discharge greater than September 30, 2014 will not be accepted.

6. Does HFS have dedicated staff to ICD-10 conversion?
   
   Yes, HFS has a dedicated team tasked specifically to ICD-10 conversion.

7. How is HFS readiness when considering ICD-10 conversion?
   
   Currently, HFS is on task and all requirements for ICD-10 conversion are on schedule.  HFS will “go live” with ICD-10 on October 1, 2014.

8. When will HFS publish policy and notices concerning ICD-10?
   
   The goal of the Department is to get notices and policies concerning ICD-10 published by either late spring or early summer of 2014.

9. Will vendors be able to test with HFS before October 1, 2014?
   
   Due to technological constraints HFS will not be providing a platform for end to end testing for external vendors.

10. Do all HFS-enrolled providers have to use ICD-10 coding?
    
    Yes, all providers whose claims require a Diagnosis code must use ICD-10 diagnosis codes on the claim.

The Centers for Medicare & Medicaid (CMS) provides extensive information, facts sheets, tools, and resources for providers, vendors and payers for implementing ICD-10.  We are providing the following link to assist you with your ICD-10 efforts.  For more information, visit the CMS website with ICD-10 updates.

Theresa A. Eagleson, Administrator

Division of Medical Programs