Currently, health care entities are required by Federal regulations to use a standard code set to indicate diagnoses and procedures on transactions. For diagnoses, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set is used. For inpatient hospital procedures, the ICD-9 procedure code set (PCS) is used. Effective October 1, 2014, the standard code set that is required for diagnosis codes is changing to the ICD-10-CM and the standard code set that is required for inpatient hospital procedures is changing to the ICD-10-PCS. The effective date of the ICD-10 conversion is not likely to be delayed. Other procedure code sets known as Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) used in other claims transactions are not changing.
These codes are used in almost every clinical and administrative process and system, which will necessitate changes and adjustments in many areas of health care payment and reporting. Reasons for making these code set changes are irrefutable. The practice of medicine has changed dramatically in the last several decades. Many new conditions have been discovered, many new treatments developed, and many new types of medical devices have been made available to patients. The ICD-9 code set is not capable of being enhanced to add codes or to capture new and emerging health concerns. The ICD-10 code set will enable a much better description of the current practice of medicine and has the flexibility to adapt as medicine changes.
The Agency for Health Care Administration is beginning the activities needed to prepare Florida Medicaid for the changes in the diagnosis code set. The ICD-10 Transition Project contains five distinct areas of activities and tasks:
- Impact Analysis: Conduct an ICD-10 Impact Analysis.
- Medicaid Policy Changes: Develop changes in Medicaid policy that govern the use of diagnosis and inpatient hospital procedure codes.
- Medicaid Reimbursement Rates: Develop the most appropriate reimbursement rates for the new diagnosis/procedure code system in a budget neutral manner.
- Outreach and Training: Conduct provider training for the Medicaid changes needed for the ICD-10 transition. This training will not be “code set training,” but rather an opportunity to explain the impact of changes in Medicaid policies and reimbursement rates required because of the change in the code set.
- Update the Florida Medicaid Management Information System (FMMIS) to reflect the new policy and reimbursement rates.
The plans that are being made now will follow the timeline below. CSG Government Solutions has been chosen to assist the Agency in completing the tasks and activities required for a successful transition.