Medicaid Programs Prepare for ICD-10 Code Update

by Kristi Sheakley, PMP®, Director, Consulting Services, Payment Method Development, Conduent Health

Medicaid payers and providers are counting down to an explosion of ICD-10 coding changes on October 1, 2017. Currently posted to the Centers for Medicare and Medicaid (CMS) website, the ICD-10-CM and ICD-10-PCS updates include 360 new diagnosis codes and 3,562 new surgical procedure codes.

ICD-9 and ICD-10 code changes have been frozen since 2011 due to ICD-10’s long-delayed implementation, which finally came on October 1, 2015. During that time, there were no regular, annual updates – only minor revisions. The first wave of changes came on October 1, 2016, with 1,943 new diagnosis codes and 3,651 new procedure codes.

Now a second wave of coding changes is about to hit, the result of catching up with years of putting off updates. Just like last year, the large volume of updates will require Medicaid programs to allocate significantly more resources into evaluation and remediation efforts across areas such as business rules, service authorization criteria, third-party liability (TPL) criteria, program integrity review and data analytics. Medicaid programs must get an early start on the analysis activities to avoid being unprepared when the codes go into effect.

The new edition of Medicaid Payment Perspectives highlights important coding changes to areas that include:

  • substance abuse
  • antenatal screening
  • myocardial infarction
  • heart failure

It also reviews points Medicaid programs should consider as they upgrade their systems. You can learn more here.

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