FY 2020 ICD-10 code updates: what Medicaid programs should expect  

Medicaid payers and providers are gearing up for over a thousand coding changes to the International Classification of Diseases (ICD) 10th revision, in fiscal year (FY) 2020. The latest round of ICD updates are scheduled for implementation starting October 1, 2019. 

ICD-10 is a global cataloging system for codes that track various health interventions taken by medical professionals. ICD-10-Clinical Modification (ICD-10-CM) describes the code set for diagnosis coding used for all healthcare settings in the United States. ICD-10-Procedure Coding System (ICD-10-PCS) is used in hospital inpatient settings, for inpatient procedure coding. 

In total, there are 1,007 new codes and 2,077 deleted codes, along with 32 revisions. The revisions include 734 additions and 2,056 invalidations, with two revisions set for ICD-10-PCS. The full list of ICD-10-CM diagnosis codes are available here.  Meanwhile, the new ICD-10-PCS codes are available here. These codes are for dates of service between October 1, 2019 and September 30, 2020.  

How Changes Impact Medicaid Programs 

Due to the large volume of code changes, Medicaid programs must allocate significantly more resources to evaluation and remediation efforts across their systems. Business rules, service authorization criteria, TPL criteria, program integrity review and data analytics are just a few systems areas that may require additional evaluation and remediation. Medicaid programs must get an early start on the analysis activities that will be required to avoid being caught unprepared when the new codes go into effect. 

The Conduent Payment Method Development (PMD) team has certified coders with experience in assisting state Medicaid agencies and/or fiscal agents in reviewing the code changes in relation to established policy. Our PMD team analyzes the existing system parameters, system lists, TPL criteria, and other logic assigned to current codes and mimics that policy for new codes, by understanding the descriptions and definitions of the new codes.  Several internal crosschecks are applied to assure consistency. 

If you are interested in learning more about how the Conduent PMD team can help you, please contact Genia Kelley at genia.kelley@conduent.com, or feel free to forward her email address to your state clients who may be interested.