MedicaidBilling CodesHigh impact
Newsletter Vol. 23, No.10
New Jersey Medicaid·NJ·Coding
Effective date
Oct 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare is transitioning from ICD-9-CM/PCS to ICD-10-CM/PCS coding effective October 1, 2014. All claims with service dates ending on or after this date must use ICD-10 diagnosis and inpatient procedure codes; claims submitted with ICD-9 codes will be denied. Providers must update billing systems to Version 5010 standards and ensure software can generate the more specific 3-7 digit ICD-10-CM codes and 7-character alphanumeric ICD-10-PCS codes.
Action Required
By October 1, 2014: Billing team must complete the following:
1. Update all billing software and systems to Version 5010 HIPAA standards (required since January 1, 2012, but critical for ICD-10 compliance)
2. Configure billing system to accept and validate only ICD-10-CM diagnosis codes (3-7 digits) and ICD-10-PCS inpatient procedure codes (7 alphanumeric characters)
3. Ensure system rejects invalid ICD-10 codes (subcategories with more detailed codes beneath them, e.g., M87.01 is invalid; only M87.00 or M87.011/012/019 are valid)
4. Update encounter forms and provider templates to reflect ICD-10 coding requirements
5. Configure system to use 'Service Date Through' field for determining code set compliance; for inpatient hospital claims, base compliance on discharge date
6. Note: Decimal points should NOT be included in HIPAA transactions (system must strip or not transmit them); decimal points are eliminated entirely for ICD-10-PCS
7. Train all coding and billing staff on ICD-10 specificity requirements and the expanded code structure
8. Test ICD-10 submission capability through https://www.njmmis.com (testing available January 2014)
Consequences: Claims with service dates on or after October 1, 2014 submitted with ICD-9 codes will be denied payment by the State of New Jersey. Early adoption of ICD-10 codes prior to the compliance deadline is not permitted.