On January 16, 2009, the U.S. Department of Health and Human Services (HHS) published a final rule on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10 CM/PCS), requiring all HIPAA-covered entities to adopt the ICD-10- CM/PCS (diagnosis/inpatient procedure codes) by October 1, 2014.

  • ICD-10-CM is for use in all U.S. health care settings.  Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
  • ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding.  Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

Effective October 1, 2014, claims submitted to the South Carolina Department of Health and Human Services (SCDHHS) must include the ICD-10 diagnosis codes for any claim with a date of service or date of discharge on or after October 1, 2014.  A claim with a date of service or date of discharge prior to October 1, 2014 must contain ICD-9 codes. 

A dedicated webpage will be used to communicate key information to providers related to the preparation and implementation of ICD-10 and access to various Survey Monkey links that will help us gauge provider readiness. Also featured will be a new section, “What Would You Code?” to help you understand how to code using ICD-10 principles.  SCDHHS will continue to inform providers of the status of its ICD-10 implementation by sending additional announcements and/or bulletins and continue posting relevant information on the ICD-10 webpage (https://www.scdhhs.gov/icd-10).  Providers should monitor this page to view important SCDHHS ICD-10 information as it becomes available.

This bulletin applies to Fee-For-Service and Medical Homes Networks (MHNs).  Please monitor the appropriate Managed Care Organization (MCO) for their instruction regarding ICD-10 implementation.  If you have any questions concerning this announcement, please contact the SC Medicaid Provider Service Center at (888) 289-0709.  Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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