Medicaid Alert - MA2015-05

By October 1, 2015: (1) Billing team must update all claim submission systems to require ICD-10-CM/PCS diagnosis and procedure codes for all inpatient hospital discharges on or after this date. (2) Configure billing software to use discharge date (not admission date) to determine which code set to report. (3) For inpatient claims spanning the implementation date, ensure the entire claim uses ICD-10 if discharge is on or after October 1, 2015. (4) For outpatient claims with mixed service dates, split claims so that dates through September 30, 2015 use ICD-9-CM, and dates on/after October 1, 2015 use ICD-10-CM. (5) Train all clinical and billing staff that only valid, HIPAA-compliant ICD-10-CM/PCS codes with 3-7 characters are acceptable; unspecified codes are only acceptable when clinical documentation does not support specificity. (6) Do NOT attempt to obtain ICD-10 equivalency mappings from the state—providers are responsible for accurate coding. (7) Hospitals experiencing DRG shifts during transition can contact DMAHS Office of Reimbursement (609-588-2668) for claim review. Consequences: Claims without valid ICD-10 codes will be denied by NJFC/Medicaid for all discharges on or after October 1, 2015.