ICD-10 - Frequently Asked Questions

Will MaineCare accept ICD-9 claims after October 1, 2015?

For all discharges and dates of service on or after October 1, 2015, diagnosis and procedure codes must be submitted using ICD-10 codes in order to receive reimbursement. Claims for discharges and dates of service prior to October 1, 2015 should be submitted using the ICD-9 codes. Claims will deny if the diagnosis code submitted for dates of service on or after October 1, 2015, is not an ICD-10 code.

Is MaineCare responsible for ensuring that providers are using appropriate ICD-10 codes?
No.  Providers are responsible for submitting claims with correct ICD-10 codes.

What materials are available to assist providers with crosswalking between ICD-9 and ICD-10 codes?
CMS provides General Equivalence Mappings (GEMs), which is a tool that defines reasonable alternatives for mappings between ICD-9 and ICD-10.  You can download this tool for free here.

Will MaineCare issue new policies based on ICD-10?
MaineCare is actively reviewing its policies to ensure that they reflect the updated ICD-10 codes.  Any changes to policies will be published and communicated in the News and Updates.

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Will MaineCare accept files with both ICD-9 and ICD-10 codes?
ICD codes are driven by date of service. If the date of service is prior to 10/01/15, ICD-9 codes should be used, but if the date of service is on or after 10/1/15, ICD-10 codes should be used. MaineCare is able to accept both ICD-9 and ICD-10 codes in the same file, as long as the claim is properly coded with ICD-9 codes for dates of service prior to 10/01/15, and ICD-10 codes for dates of service on or after 10/01/15.

Will MaineCare conduct testing?
Yes, MaineCare will be pilot testing for ICD-10.  At this time, MaineCare has not yet determined which providers and entities it will test with.  Updates will be provided as they become available.

When will partner (pilot) testing begin with MaineCare?
Partner (pilot) testing should begin during spring 2015. Please look out for additional communications regarding testing this winter.

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Who is impacted by the transition to ICD-10?
All entities covered under HIPAA must transition to ICD-10.  This includes providers, payers, and clearinghouses.  If you are unsure if you are covered under HIPAA, please check the CMS webpage regarding HIPAA covered entities.

Will providers need new provider agreements because of ICD-10?
No.  Provider agreements do not contain procedure or diagnosis codes; therefore, no changes are necessary.   

Does/will MaineCare use diagnosis codes to adjudicate dental claims?

MaineCare currently does not use diagnosis codes for processing dental claims with the exception of the 101 ANUG diagnosis.  The 2006 ADA form that is currently in use does not have a field for dental diagnosis codes.  MaineCare is currently conducting an adoption analysis of the 2012 ADA form and we will notify providers once a decision has been made concerning implementation.

When will MaineCare be implementing the CDT 2013 codes? 

A message was sent to providers via listserv regarding 2013 dental codes on January 22, 2013.  It stated that code D1203 had been replaced with code D1208.  The remaining 2013 MaineCare covered dental codes will soon be available and MaineCare will notify providers when they can be billed.  You can subscribe to MaineCare email updates on the Mailing List Web Subscription webpage.

Can MaineCare accept the ADA 2010 (J430D) form for paper claims?

MaineCare is reviewing the use of this form.  Currently, the form is not being accepted.

How are ICD-10 Codes Different from ICD-9 Codes?

Please see slide 4 of the Regional Forums presentation for a specific example of a coding change. In addition, overall differences between ICD-9 and ICD-10 codes are listed below. 

ICD-9 Codes                                                      ICD-10 Codes

Three to five characters                       --------------> Up to seven characters

Approx. 14,000 diagnosis codes          --------------> Approx. 69,000 diagnosis codes

Approx. 4,000 procedure codes           --------------> Approx. 72,000 procedure codes

Does not include laterality                   --------------> Diagnosis codes include laterality

Has no place holders                          --------------> Diagnosis codes can include place holders

Will the claims submission process for MaineCare remain the same after the ICD-10 implementation? 

Yes, the claims submission process will remain the same after the ICD-10 implementation.

Will MaineCare offer training? Where can I find training for my staff?

MaineCare will not provide training for your staff. It is your responsibility to assess their training needs and identify training programs to fulfill those specific needs. CMS provides a list of resources for training on their Provider Resources website.

How will the ICD-10 implementation affect my payment? 

With the transition to ICD-10, you will continue to be reimbursed based on the services rendered.  Payment cycle schedules will not be impacted by this transition. You will also continue to receive Remittance Advices in accordance with the current schedule.

Are Diagnostic and Statistical Manual of Mental Disorders (DSM) codes changing with the transition to ICD-10?

DSMs are used in some practices to make clinical and billing decisions. While DSM-IV included ICD-9 codes, DSM-V has been updated to include both ICD-9 and ICD-10 codes.

How do I code a claim for dates of service that span the ICD-10 implementation date?

A split billing process has been developed for these cases. Please refer to CMS Medicare Learning Network (MLN) guidelines for specific information by bill type.

Will there be more documentation required due to ICD-10's level of specificity?

Documentation should still be based on the services rendered. If more specific information is required based on the services rendered, additional documentation will be necessary. The responsibility remains with you to appropriately document and submit claims based on your specialty and the services rendered.

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Contact Us

Do you have questions about ICD-10? An ICD-10 e-mail box is available specifically for your ICD-10 related questions.

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