Get Your ICD-10 Coding Questions Answered!
The OMA ICD-10 email hotline is now open! OMA members or their staff may contact the OMA with their specific ICD-10 coding questions and receive responses from a coding professional dedicated to addressing your coding issues.
E-mail firstname.lastname@example.org or click the button below to submit your ICD-10 coding question.
OHA/DMAP Explains How to Avoid Fee-for-Service (FFS) Prior Authorization Denials
FFS claims for non-pharmacy services that are prior-authorized with an ICD-9 diagnosis code will be denied for dates of service on and after October 1, 2015. On September 29, 2015, OHA/DMAP released an updated announcement detailing a temporary process which will allow for emailed DMAP multiple PA updates via a single spreadsheet they have created. This temporary process will begin immediately and end on October 31, 2015.
Read the announcement letter, updated on September 29, 2015 for full instructions and to access the link to the spreadsheet. Call the PA Hotline at 1-800-642-8635 for questions.
Report Your Medicare Specific ICD-10 Problems and Complaints to CMS' ICD-10 Ombudsman
All claims and other administrative transactions (such as eligibility, prior authorization and others) for dates of service on and after Oct. 1, 2015, must have an ICD-10 diagnosis code. All transactions with ICD-9 diagnosis codes will be rejected.
Problems with Medicare Claims? If you experience any problems in the processing of your Medicare claims, please complete and submit AMA's ICD-10 complaint form.
Please note: This is for Medicare only. Forms will be sent directly to the Centers for Medicare & Medicaid Services (CMS). Sending this email constitutes your authorization for the information to be supplied to CMS. The American Medical Association will not provide individual responses to each complaint.
There are also other steps you can take to address the issues you are having.
- If the payer is Medicare:
- Check your Medicare Administrative Contractor (MAC) website for information on problems they are addressing and for a method of contact for ICD-10 issues.
- If the payer is Medicaid, check the state Medicaid website for information and method of contact.
- If the payer is a commercial payer, check their website for information and method of contact.
- If you are having issues with your practice management system or electronic health record (EHR), contact your vendor.
- If you are having issues with your billing vendor or clearinghouse, contact them.
- For advice on handling problems and to find out if other practices are experiencing similar issues, contact your state or specialty medical society.
Register Today for DMAP's ICD-10 Q + A Webinars to Get Your Questions Answered!
DMAP has scheduled three Q + A webinar sessions.
Your Most Common Codes - Translated to ICD-10-CM
The newest addition to CMS' RoadTo10 is the release of a Specialty Guides series. There are six medical specialties targeted; Family Practice, Internal Medicine, OB/GYN, Cardiology, Orthopedics, and Pediatrics. Each guide includes ICD-10-CM codes commonly encountered within the specialty, clinical documentation tips, and clinical scenarios. Download one or all of the concept guides here.
CMS and AMA Announce Flexibility Efforts to Help Providers with ICD-10 Implementation
In a July 6, 2015 press release, the organizations announced the following guidance which affects Medicare Part B Fee for Service claims:
"Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set."
Upcoming milestones of CMS' updated implementation operating plan were also detailed and include:
- Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities. To read a copy of the letter, click here.
- CMS will set up a communication and collaboration center to identify and initiate resolution of ICD-10 related issues. As a part of the center, CMS has named Dr. William Rogers as the ICD-10 Ombudsman to triage and answer questions about the submission of claims. You may contact Dr. Rogers with ICD-10 questions at email@example.com
- For 12 months after ICD-10 implementation, Medicare Administrative Contractors (MAC) will not deny Part B claims based solely on the specificity of the ICD-10 diagnosis code, as long as the ICD-10 code used was a valid code from the right family. Despite this flexibility, accurate ICD-10-CM codes will be required for claims processing. It is also important to keep the following items in mind:
- Without the accurate ICD-10-CM code, the Part B claim will be considered invalid and will be sent back to the provider for correction
- Other payers are not required to adhere to this flexibility guidance or "grace period"; this applies solely to Medicare Part B claims. Refer to your other payers' websites for their ICD-10 policies
- This flexibility guidance will not change the specific ICD-10 codes that individual NCD and LCD policies require
- Part B Medicare Administrative Contractors (MAC) may have advance payment available
- Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information [on their websites] on how to access advance payments
- NOTE: CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered; therefore it is critical for providers to test prior to implementation
- Offering ongoing Medicare acknowledgement testing for providers through September 30.
- Providing additional in-person training through the “Road to 10” for small physician practices.
- Hosting an MLN Connects National Provider Call on August 27.
CMS - 2015 Testing
Acknowlegement testing: Providers, clearinghouses and others are welcome to submit acknowlegment test claims now up to October 1, 2015. Additionally, each MAC will highlight acknowledgement testing by providing 3 separate but dedicated weeks in which real-time help desk support will be provided during those weeks. The acknowledgement testing weeks will occur in: November 2014, March 2015, and June 2015. Refer to Noridian's website for more information about this testing.Remember, acknowlegement test claims will not be adjudicated but rather an 277A acknowlegment will be returned to you confirming that the test claim was accepted or rejected.
End-to-end testing: The last 2015 end-to-end testing with CMS will take place in July; testing volunteer registration is closed and all volunteers have been chosen. Read more about CMS' testing in the CMS MLN Matters, edition number SE1409.
CMS' Road to 10 Resources for Small Physician Practices
This website contains a plethora of resources as well as interactive tools that will create personal action plans for your practice. For example, creating an ICD-10 implementation plan and communicating with more of your vendors are crucial to a successful ICD-10 transition; CMS has created a road map on how to prepare for small, medium and/or large practice transitions, as well as a comprehensive list of questions to ask vendors for you.
In addition to the resources and interactive tools, Road to 10 offers a template library that contains Assessment and Question lists for diagnosis inventory and your vendors (e.g. technology, billing service, clearinghouse, and payer). Learn more.
Learn more about all the website has to offer.
The transition to ICD-10 will involve all aspects of the medical practice and as such will require training for coding and billing staff as well physicians and other clinical staff and office staff.
The OMA has developed a comprehensive educational program that will provide targeted trainings at various stages of the ICD-10 implementation timeline, as well as newsletters, case studies and an ICD-10 hotline.
OMA Member Benefits
Ready10 tools offer fast, easy, and affordable tools that will help your practice ensure a successful transition to ICD-10:
- Special FREE member offer! Order the web-based Ready10™ Translator for FREE today! The translator converts ICD-9 codes to more specific ICD-10 codes in seconds. This proprietary crosswalk tool is accessible from any computer and features multiple code lookups, bi-directional conversion, print capabilities, and the ability to save favorites and create flash cards to serve as documentation training tools for your entire staff.
- The Ready10™ Basic delivers everything you need to prepare and manage your practice through the transition – all in one place. It’s a user-friendly, comprehensive step-by-step road map for the ICD-10 transition that works as a web-based “virtual consultant” and includes all the tools needed for a smooth transition.
- The Ready10™ Pro includes everything from the Ready10 Basic package plus five hours of personalized, expert consulting, plus review of 50 charts to see how your current documentation practices stack up to ICD-10’s increased specificity. With the help of Ready10 Pro, your entire practice will be fully engaged and ready for the transition.
Learn more and order these valuable resources today at www.cpticdpros.com/OMA.
ICD-10 coding books from the AMA can help with your implementation and planning. Publications include:
- 2016 ICD-10-CM Codebook
- 2016 ICD-10-CM Mappings
- Advanced Anatomy and Physiology for ICD-10-CM/PCS 2016.
Managing Your Transition to ICD-10 Newsletter
This periodic OMA newsletter provides ICD-10 information including fact sheets, coding case studies, GEMS updates, preparation tips and hands-on exercises to assist in your practice's preparation.
- Issue No. 21 - September 2015
- Issue No. 20 - August 2015
- Issue No. 19- July 2015
- Issue No. 18 - June 2015
- Issue No. 17 - May 2015
- Issue No. 16 - April 16, 2015
ICD-10: Practices - Restart Your Engines!
- Issue No. 15 - March 19, 2015
What’s in Your ICD-10 Tool Box? An Inventory of ICD-10 Coding Support Tools
- Issue No. 14 - January 29, 2015
ICD-10 Preparation: Rethinking Your Strategy
- Issue No. 13 - October 16, 2014
ICD-10 Questions, Myths and Preparedness...Oh My!
- Issue No. 12 - June 23, 2014
Maintiaining Your Training Momentum
- Issue No. 11 - March 26, 2014
Workflows & Support Tools
- Issue No. 10 - February 19, 2014
ICD-10, 9, 8, 7 Months and Counting!
- Issue No. 9 - January 17, 2014
ICD-10 Countdown: Focus on Education
- Issue No. 8 - December 12, 2013
ICD-10 Testing and Documentation
- Issue No. 7 - November 7, 2013
Addressing the Documentation Gap to Support ICD-10-CM
- Issue No. 6 - September 12, 2013
ICD-10 Mapping and GEMS: new updates
- Issue No. 5 - March 20, 2013
Applying our 5010 lessons to ICD-10 preparation
- Issue No. 4 - August 3, 2012
The health care industry has not stopped preparing for ICD-10, have you?
- Issue No. 3 - January 9, 2012
Budgeting for ICD-10
- Issue No. 2 - September 28, 2011
ICD-10-CM: Impact to the Code Assignment Process
- Issue No. 1 - September 8, 2011
Medicine In Oregon Magazine (ICD-10 articles)
- ICD-10-CM and Unspecified Codes
By Carol Wintermute; Winter 2014
- The ICD-10 Deadline is Less than a Year Away. Will You Be Ready?
Ease your transition to ICD-10 with the Help of OMA resources; Fall 2013
- Things You Should Know about ICD-10
By Joy Conklin, interviewing Nancy Fisher; Summer 2013
- The Physicians Role in Better Health Information
By Joseph Nichols; Winter 2013
- New OMA Member Benefit Can Help with ICD-10
By Denny Flint; Spring 2013
- It’s Time to Get Moving on ICD-10
By Stanley Nachimson; Fall 2012
- Is Your Documentation Ready for ICD-10?
By Carol WIntermute; Summer 2011
- ICD-10 Web Page
- AMA Preparation Tool: Assess Your Documentation in Preparation for ICD-10
- AMA Preparation Tool: Determine Your Training Needs for ICD-10
- AMA Preparation Tool: Talk To Your Vendor about ICD-10 Updates
- DMAP GEMS in Oregon Data
- According to DMAP’s website, they expect to begin testing in early 2014. Further, DMAP does not plan to support ICD-9 codes for dates of service after the ICD-10 compliance date, and they plan to closely follow communications from CMS on this. For details, visit www.oregon.gov/oha/healthplan/Pages/providers.aspx and type "ICD-10" in the Search box.
- ICD-10 Team, email contacts: pre-implementation/basic project updates: StateOregon.ICD10@state.us.or.us ; Post-Implementation date help: OHAICD10.firstname.lastname@example.org
- ICD-10 Web Page
- FAQs: ICD-10 Transition Basics
- CMS’ Provider Dedicated Resources Web Page
- Introduction to ICD-10: A Guide for Providers (CMS eHealth University)
- ICD-10 Myths & Facts
- ICD-10-CM/PCS: The Next Generation of Coding
- Fact Sheet SE1325: Institutional Services Split Claims Billing Instructions
- MLN Connects Videos
- ICD-10 Coding Basics: Sue Bowman from the American Health Information Management Association (AHIMA) provides a basic introduction to ICD-10 coding, including similarities and differences from ICD-9; ICD-10 code structure; and coding process and examples.
- Log-in to the provider portal to access ICD-10 information within the website.
- Listing of Prior Authorization ICD-10 diagnosis code requirements by Payer. View list: http://www.onehealthport.com/icd10_countdown