Coding Requirements. (1) The MCO must use the most current version of the following coding sources, unless otherwise precluded from doing so by state or federal law: (a) Diagnosis codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM). (b) Procedure codes obtained from the International Classification of Diseases, Clinical Modification (ICD-9-CM) for inpatient claims. (c) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2). (d) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78. (e) National Drug Codes. (2) The MCO and its subcontractors must utilize the coding sources as defined in this section and follow the instructions and guidelines set forth in the most current versions of ICD-9-CM, HCPCS and CPT. (3) Neither the MCO nor its subcontractors may redefine or substitute these required codes. (4) HIPAA compliant codes must be submitted on encounter data.
Appears in 2 contracts
Sources: Contract for Medical Assistance and Minnesotacare Medical Care Services, Contract for Medical Assistance and Minnesotacare Medical Care Services