ICD-10, or The International Classification of Diseases, 10th Revision, went into effect October 1, 2015. It is a revision of the ICD-9-CM system which physicians and other providers have used to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices.
More information about ICD-10 can be located at https://www.cms.gov/medicare/coding/icd10/index.html As well, the MO HealthNet Division (MHD) has information available at their website (click to link to the most recent bulletin).
The change to ICD-10 does not affect the Current Procedural Terminology (CPT) and Health Care Procedural Coding System (HCPCS) coding for outpatient procedures. An example of a CPT/HCPCS code is S5100, used to bill Medicaid for Adult Day Care Services.
The Missouri Medicaid Audit and Compliance Unit (MMAC) has received questions from Adult Day Care providers regarding ICD-10. Providers want to know if MMAC auditors review ICD-10 codes as part of their audit processes. To determine proper billing, MMAC auditors will ensure Medicaid participants are authorized for the services billed, that the services billed were actually performed, and are properly documented. This involves a review of the billing codes, such as S5100. MMAC auditors do not routinely review ICD-10 codes as part of the Adult Day Care Waiver Program audit process. If an ICD-10 code appears incorrect, an auditor will bring this to the attention of the provider and the Department of Health and Senior Services, but it does not affect the billing process and would not result in an error during an audit.
Please contact MMAC at email@example.com if you have any questions.