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The International Classification of Diseases (ICD) is the international standard diagnostic classification for general epidemiological, health management, and clinical use. As part of HIPAA Administrative Simplification, the United States HHS mandated that all health care entities upgrade diagnosis (ICD-9-CM) and inpatient procedure codes (ICD-9-PCS) to ICD-10-CM and ICD-10-PCS, respectively. The ICD-10 code set is a full replacement of the ICD-9 code set that will provide additional granularity for diagnosis and procedure codes.
All discharges and services with a date of service on or after October 1, 2015 will need ICD-10 codes. Please select the link to view the final rule (PDF*)
- Code Differences Document
- Durable Medical Equipment: EDI X12
- September 2015 Health PAS Online Portal Changes
- Methadone Cinics Billing Procedures
- Billing for Down Syndrome: Physicians Coding Guidance - Updated October 2015
- Post Implementation Update: EDI Rejection Focus
- Prior Authorization Fact Sheet Updated September 2015
- Section 45 Non-Emergent Use of Emergency Department: ICD-9 to ICD-10 Code Crosswalk
- Section 45 Non-Emergent Use of Emergency Department: ICD-10 Codes
- Split Billing Rules for Cutover Updated October 2015
- Top EDI Rejection Reasons: Rejections Identified in Pilot Testing
MaineCare is actively preparing its employees, processes and systems for the transition to ICD-10. We will provide regular updates on the progress of our transition. For more information, visit Frequently Asked Questions.
Post- Implementation Webinars
We are hosting five additional ICD-10 webinars to aid service providers. The material will be similar to that covered in the August webinars, along with the most common EDI rejection reasons, to help you avoid common claims submission errors.
The dates and times are as follows:
- Thursday, 10/15 9:00-10:00
- Tuesday, 10/20 2:00-3:00
- Thursday, 10/22 10:00-11:00
- Tuesday, 10/27 10:00-11:00
- Thursday, 10/29 2:00-3:00
To register, please email the ICD-10 email box with your name, NPI, and the date that you would like to attend.
MaineCare Services hosted several ICD-10 webinars for providers during the summer of 2015. Select the links below to view the PowerPoint presentations from the webinar series:
Member Advisory Meeting Materials
Presentations for Provider Meetings
- June 2015 ICD-10 Presentation for the Maine Child Health Improvement Partnership (.pdf)
- June 2015 ICD-10 Dental Presentation (.pdf)
- June 2015 PAG/TAG Presentation (.pdf)
Provider Type Specific Presentations
- Letter to ID and ASD Waiver Providers
- ID/ASD Waiver ICD-9 to ICD-10 Code Crosswalk
- Letter to Residential and Family Care Facilities
MaineCare recently completed analyzing the results of our ICD-10 Provider Readiness Survey. As a result of feedback from survey participants, MaineCare has developed an ICD-10 Informational Series for providers in order to share information and to direct you towards preparing for transitioning from ICD-9 to ICD-10.
The informational series will include the following parts or topics:
- Part I: Overview of Provider Survey Results (,pdf)
- Part II: MaineCare's Provider Outreach Plan (.pdf)
- Part III: ICD-10 Provider Impact (.pdf)
- Part IV: Example of Coding Changes (.pdf)
- Part V: Provider Preparation/Helpful Hints (.pdf)
The Provider Readiness Survey was open from April 20, 2015 to May 5, 2015. MaineCare received 447 responses to the survey. We have completed reviewing the survey and will use the responses to draft communications for the next few weeks. The Survey Summary document provides a high level overview of survey responses.
- CMS ICD-10 Webpage
- 2015 General Equivalence Mappings (GEMs) Tool- Valid for submitting codes on, or before, December 31, 2015
- 2016 GEMs Tool- Required for submitting codes on, or after, January 1, 2016
- HIPAA Version 5010
Do you have questions about ICD-10? Contact Provider Services through email or call 1-866-690-5585. (TTY: 711).