Highlight on North Carolina: NC ramps up for ICD-10, provides fun coding facts

NCTracks, a new multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services (NC-DHHS) has used a “RAMP UP to ICD-10” project to assist provider organizations with the transition from ICD–9 to the ICD-10 code sets.

ICD-10 Background

On January 16, 2009, HHS posted a Final rule that would replace ICD-9 (International Classification of Diseases, 9th Revision, Clinical Modification) code sets for all Health Insurance Portability and Accountability Act (HIPAA) covered entities with ICD–10–CM (10th Revision, Clinical Modification) for diagnosis coding, and ICD–10–PCS (10th Revision, Procedure Coding System) for inpatient hospital procedure coding, effective October 1, 2013.

On August 24, 2012, HHS posted a Final rule that extended the compliance date to October 1, 2014. Congress voted to extend the October 1, 2014 ICD-10 implementation date for one year, until October 1, 2015.

The new ICD-10 code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code.  The number of diagnosis/procedure codes is greatly expanded from about 17,000 to over 150,000 codes. Examples of the enhancements made with ICD-10 include:

  • Reporting of laterality (right vs. left designations), reflecting the importance of which side of the body or limb (e.g., left arm, left kidney, left eye) is the subject of the evaluation.
  • Restructured reporting of obstetric diagnoses. In ICD-9-CM, the patient is classified by diagnosis in relation to the episode of care. In ICD-10-CM, the patient is classified by diagnosis in relation to the patient’s trimester of pregnancy.

CMS has a webpage dedicated to the ICD-10 rollout. NCTracks also has a webpage with answers to frequently asked questions regarding ICD-10.


To help organizations prepare for ICD-10 implementation, NCTracks offered a series of topics intended to assist North Carolina providers in navigating the activities that needed to be done. RAMP UP stands for: Research, Assessment, Mapping, Process Improvement and Training, Update System(s) with Vendors, and Perform Testing. A brief description of each topic follows:

  • Research. A successful transition to ICD- 10 requires significant research and planning, including effective communication to stakeholders.
  • Assessment. The starting point for ICD-10 transition is an assessment to understand the role and location of ICD-9 codes across all systems, processes, policies and reports. Providers must identify business areas affected by ICD-10 and determine the level of support needed for successful transition.
  • Mapping. The process of evaluating and documenting the relationship between ICD-9 and ICD-10 code sets is a major aspect of preparing for ICD-10. While the General Equivalence Maps (GEMS) developed by CMS are a great starting point, for mapping they do not cover all of the potential ICD-9 to ICD-10 relationships, so additional analysis may be necessary. NCTracks has created a helpful crosswalk connecting the old ICD-9 codes to the new ICD-10 codes.
  • Process improvement and training. The move from ICD-9 to ICD-10 will affect not only computer systems, but business processes as well. Successful implementation will require evaluation and update of all aspects of provider business operations to coincide with the technical changes. This will include training to ensure the staff acquires the necessary skills and knowledge on the processes, procedures, policies, and system updates affected by the ICD-10 transition.
  • Update system(s) with vendors. The activities in research, assessment, mapping, and process improvement lead up to updating of computer system(s) for ICD-10. Part of updating computer systems involves vendor coordination to synchronize changes to inbound and outbound external interfaces.
  • Perform testing. Thorough testing ensures that business functions will continue normally throughout the transition. A rigorous testing methodology, documented test plan, and accurate test data are integral to achieving results that meet expectations.

North Carolina Ready for ICD-10 Launch

On April 30, 2014, NCTracks reported that it has completed 10 months of internal testing activities and recently started external testing with providers, which will continue through August 2015. It selected providers representing a diversity of practices, specialties and facilities.

According to NCTracks, system integration testing started in June 2014, and by November 2014, improvements had been made so that 100 percent of claims passed. In December 2014, NC-DHHS staff began user acceptance testing with CSC, the fiscal agent that manages NCTracks. This testing ran through mid-April 2015 using various scenarios. CSC ran selected transactions for professional, dental and institutional claims, representing a minimum of 10,000 claims. CSC converted all submitted ICD-9 codes to an ICD-10 equivalent using a crosswalk table, then compared and validated the results from the test against previous production claims.

Fun Facts

NCTracks has also posted some “ICD-10 Fun Facts Sheets” highlighting the greater specificity and unusual nature of some of the diagnosis and procedure codes coming with ICD-10: