The International Classification of Diseases, 10th Revision (ICD-10_ medical coding system is mandated for use by the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS); replacing ICD-9 CM Volumes 1-3). ICD-10 Clinical Modification (CM) and the ICD-10 Procedure Code System will improve the ability to monitor the incidence and prevalence of diseases, track treatment and health care delivery, and prepare for Electronic Health Record (EHR) use. Due to the enhanced specificity and level of detail of the ICD-10 code set, the transition impacted the Alabama Medicaid program, health care providers and trading partners. Important information about this transition is below.
Production Prior Authorization Submissions
- Prior Authorization records submitted with requested effective dates of 10/1/15 or greater should be submitted with an ICD-10 diagnosis code.
ICD-10 - Frequently Asked Questions
Provider Electronic Solutions (PES) Software
- PES version 3.02 includes changes for ICD-10.
- The upgrade process will set all previous Claim and Prior Authorization ICD versions to ICD-9 (‘9’).
- The ICD version field on new Claims and Prior Authorizations will default to ICD-9 (‘9’).
- The Procedure/HCPCS list has been split into multiple lists:
- Procedure HCPCS (non-surgical procedure codes)
- Procedure ICD-9 (surgical procedure codes)
- Procedure ICD-10 (surgical procedure codes)
- Procedure codes currently entered on the ‘Procedure/HCPCS’ list will be moved to both ‘Procedure HCPCS’ AND “Procedure ICD-9’ when an upgrade to version 3.02 is performed. Users will need to remove invalid codes from each respective list.
- The Diagnosis list has been split into multiple lists:
- Diagnosis ICD-9
- Diagnosis ICD-10
- Diagnosis codes currently entered on the diagnosis list will be moved to the new ‘Diagnosis ICD-9’ list when an upgrade to version 3.02 is performed.
- Users may begin building ICD-10 lists now. ICD-10 codes should not be submitted until the CMS mandated date.
- Provider Electronic Solutions Software