37.85.403    ICD CLINICAL MODIFICATION (CM) AND PROCEDURAL CODING SYSTEM (PCS) SERVICES

(1) The department adopts and incorporates by reference the Diagnosis coding practice of International Classification of Diseases (ICD) published by the World Health Organization. The ICD is used as a health care classification system for diseases and health conditions.

(a) For dates of service on or before September 30, 2015, the ICD edition being utilized will be the ninth revision (ICD-9) to code the diagnosis of services.

(b) For dates of service October 1, 2015 and thereafter the ICD edition being utilized will be the tenth revision (ICD-10) to code the diagnosis of services. ICD-10 consists of the following codes sets:

(i) ICD-Clinical Modification (CM); and

(ii) ICD-Procedure Coding System (PCS).

(c) For inpatient claims with a discharge date on or after October 1, 2015, the tenth revision (ICD-10) must be utilized.

(d) Outpatient claims with dates of service that span the utilization dates must be split based on date of service in order to utilize the appropriate edition as noted in (a) and (b).

(e) Per 45 CFR 162.1002, ICD-10 will replace ICD-9 for dates of service October 1, 2015 and after. A copy of the ICD codes may be obtained at http://www.medicalcodingbooks.com/.

History: 53-2-201, 53-6-101, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA; NEW, 2014 MAR p. 507, Eff. 3/14/14; AMD, 2014 MAR p. 3074, Eff. 12/25/14.