Medi-Cal Not Ready for Full Implementation of ICD-10 on October 1


On Oct. 1, Medicaid programs in California and three states will not be fully converting from the ICD-9 to the ICD-10 coding system, as nearly everyone else is federally mandated to do. Instead, they have received CMS approval to take incoming claims coded in the new ICD-10 system, convert them into ICD-9 codes, and use the older system to calculate payments to healthcare providers.

All HIPAA-covered entities, including hospitals, office-based physicians, claims clearinghouses and health plans must comply with the federal mandate for full ICD-10 conversion on Oct. 1. But the CMS has signed off on a “crosswalk” technique to translate ICD-10 codes into ICD-9 codes and keep using the older codes as a workaround for Medicaid fee-for-service programs in California, Louisiana, Maryland and Montana. The claims processing systems in those four states are unable to perform payment calculations using the new ICD-10 codes.

In an FAQ page on the Medi-Cal website, the state agency said its crosswalk “will only be used temporarily.”

Crosswalking presents a number of potential pitfalls for healthcare providers. The risks include compromised data quality from “convoluted codes” that don't map to similar concepts in moving from one code set to another, as well as hits to providers bottom lines from delayed or rejected claims due to cross-coding issues.

Additionally, Medi-Cal is refusing to publish its crosswalk methodology, which concerns some experts, because any flaws the state might have in its methodology or technology will be hidden behind the veil of its propriety crosswalk and will work against providers in claims disputes.

James Conn; Modern Healthcare, 9/4/2015