The Workgroup for Electronic Data Interchange has released two state ICD-10 resources—the ICD-10 State Workers' Compensation Readiness List and a List of State Medicaid Sites with ICD-10 Information.

“ICD-10 is only for HIPAA-covered entities. However, workers’ compensation—which is a big issue—is not covered under the national mandate,” and consequently is governed by a patchwork of state laws rather than federal regulations, explains Jim Daley, director of IT for BlueCross BlueShield of South Carolina and co-chair of WEDI’s ICD-10 Committee.

Consequently, state-specific requirements make it challenging for national/regional payers, providers, vendors and others to comply with these varying regulations. “It is critical that industry stakeholders are aware of the status of states’ ICD-10 readiness in order to implement the appropriate action plan to comply with both state and federal regulations come October 1, 2015, regardless of whether organizations are HIPAA covered entities,” said Sherry Wilson, co-chair of the WEDI Property and Casualty Sub-workgroup.

The ICD-10 State Workers' Compensation Readiness List lays out which states are adopting ICD-10 and which ones are not. “It’s a great resource to see the status of where your state is in terms of ICD-10 adoption for workers’ comp,” Daley says, adding that the workers’ compensation industry is increasingly aligning with HIPAA transaction and code set rules.

In addition, WEDI has put together a list of state Medicaid websites with ICD-10 information that can be used as a reference document. While Medicaid is a covered entity under HIPAA as a healthcare payer, Daley says that “a few of the states have not been able to fully migrate” their systems to ICD-10 and are using a “cross-walk approach internal to their processing.”    

Also See: Four State Medicaid Agencies to Keep Adjudicating Under ICD-9

In this approach, state Medicaid agencies “will take ICD-10 codes in but within their systems they will use some mapping to move back to ICD-9 codes for the actual processing of some of the claims—“but not all of them,” he explains. “There’s nothing in the regulation that says once you receive ICD-10 in a transaction what you have to do after that.” 

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