Common use of Coding Requirements Clause in Contracts

Coding Requirements. The MCO must use the most current version of the following coding sources: (a) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions; (b) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); (c) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78; and (d) National Drug Codes. (e) Current local home care codes including units of service. 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-10-CM/PCS, and HCPCS and CPT. The STATE may request additional information on the MCO’s ICD-10 CM/PCS implementation. Neither the MCO nor its subcontractors may redefine or substitute these required codes. HIPAA compliant codes must be submitted on encounter data.

Coding Requirements. (1) The MCO must use the most current version of the following coding sources: (a) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-ICD-10- CM/PCS coding requirements on claim and encounter data submissions;submissions;‌ (b) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); (c) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78; and; (d) National Drug Codes.; and (e) Current local home care codes including units of service. . (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-10-CM/PCS, PCS and HCPCS and CPT. The STATE may request additional information on the MCO’s ICD-10 CM/PCS implementation. . (3) Neither the MCO nor its subcontractors may redefine or substitute these required codes. . (4) HIPAA compliant codes must be submitted on encounter data.

Coding Requirements. (1) The MCO must use the most current version of the following coding sources: (a) Diagnosis and inpatient hospital procedure codes obtained from the International Classification of Diseases, Clinical Modification ICD-10-CM/PCS coding requirements on claim and encounter data submissions; (b) Procedure codes obtained from Physician’s Current Procedural Terminology (CPT) and from CMS’ Health Care Common Procedure Coding System (HCPCS Level 2); (c) American Dental Association current dental terminology codes as specified in Minnesota Statutes, § 62Q.78; and (d) National Drug Codes. (e) Current local home care codes including units of service. . (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-10-CM/PCS, and HCPCS and CPT. The STATE may request additional information on the MCO’s ICD-10 CM/PCS implementation. . (3) Neither the MCO nor its subcontractors may redefine or substitute these required codes. . (4) HIPAA compliant codes must be submitted on encounter data.