MedicaidBilling CodesHigh impact
Medicaid Alert - MA2015-06
New Jersey Medicaid·NJ·Coding
Effective date
Oct 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJ FamilyCare) requires all providers to submit ICD-10-CM diagnosis codes instead of ICD-9-CM for claims with service dates on or after October 1, 2015. Claims submitted with ICD-9-CM codes after this date will be processed but denied. Providers must report valid ICD-10-CM codes at the highest level of specificity (3-7 characters) and split claims that span the transition date to use the correct code set.
Action Required
By September 30, 2015: (1) Billing team must update all billing systems to require ICD-10-CM diagnosis codes for claims with service dates on or after October 1, 2015, and reject or flag ICD-9-CM codes after this date. (2) Providers must be trained on ICD-10-CM code selection, specificity requirements (codes must be 4-7 characters in most cases, not 3-character headers), and the requirement to report the highest level of specificity. (3) Update claim submission procedures: for claims spanning September 30 - October 1, 2015, split into two separate claims (ICD-9-CM codes for dates through 9/30/2015 and ICD-10-CM codes for dates from 10/1/2015 onward); for DME claims spanning the transition, use the 'From' date to determine the appropriate code set. (4) Front desk and providers must ensure clinical documentation supports the level of specificity required by ICD-10-CM. (5) Direct all coding/billing staff to use CMS's 2016 ICD-10-CM valid codes list (cms.gov/Medicare/Coding/ICD10) and the Road to 10 Clinical Concepts Series for accurate code selection. Consequences: Claims submitted with invalid ICD-10-CM codes, insufficient specificity, or wrong code set after 10/1/2015 will be denied by Medicaid.