ICD10 Coding Around October 1, 2015

Recent News by CMS

With the ICD-10 compliance date less than 10 days away, your practice may already be seeing patients whose claims will be submitted after the October 1 compliance date.

Remember that if the date of service was before October 1, 2015, you must submit the claim with the appropriate ICD-9 diagnosis code—even if you submit the claim on or after the ICD-10 compliance date.

For hospital inpatient reporting, “date of service” is defined as date of discharge.

The requirements outlined here apply to Medicare Fee-For-Service. More information is available on the ICD-10-CM/PCS Frequently Asked Questions web page. For questions about commercial and other government insurance plans, please check with the specific plan.

Should I Use ICD-9, ICD-10, or Both?
A claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will not pay claims containing both ICD-9 and ICD-10 codes.

  • For dates of service prior to October 1, 2015, submit claims with the appropriate ICD-9 codes.
  • For dates of service on or after October 1, 2015, submit with the appropriate ICD-10 codes.

Further guidance about coding with ICD-10 around the deadline is available in Medicare Learning Network Article SE1408.

What About Claims Spanning the Compliance Date?
CMS has guidance for providers dealing with claims spanning the compliance date:

  • MLN Matters SE1325 - Institutional services split claims billing instructions for Medicare Fee-For-Service (FFS) claims that span the compliance date
  • MLN Matters SE1408 – Medicare FFS claims processing guidance for implementing ICD-10
  • MLN Matters SE1410 – Special instructions for ICD-10-CM coding on home health episodes that span the compliance date

Will CMS Allow for Dual Processing?
CMS will not allow for dual processing of ICD-9 and ICD-10 codes after ICD-10 implementation on October 1, 2015. Many providers and payers, including Medicare, have already coded their systems to allow only ICD-10 codes beginning October 1, 2015. The scope of systems changes and testing needed to allow for dual processing would require significant resources and could not be accomplished by the October 1, 2015, implementation date. 



ICD10 is Around the Corner

Part A and Part B Providers

CMS Conducts Second Successful Medicare FFS ICD-10 End-to-End Testing Week in April

From April 27 through May 1, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in a second successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim, and submitter types.

This second end-to-end testing week demonstrated that CMS systems are ready to accept ICD-10 claims. Approximately 875 providers and billing companies participated, and testers submitted over 23,000 test claims. View the results.

Overall, participants in the April end-to-end testing week were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems. The acceptance rate for April was higher than January, with an increase in test claims submitted and a decrease in the percentage of errors related to diagnosis codes. Most of the claim rejections that occurred were due to errors unrelated to ICD-9 or ICD-10.

In addition to acknowledgement testing, which may be completed at any time, a final end-to-end testing week will be held on July 20 through 24, 2015. The opportunity to volunteer for this testing week has closed. Testers who participated in the January and April end-to-end testing weeks are automatically eligible to test again in July.

Prepare Now for ICD-10 Implementation

Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015; or accept claims that contain both ICD-9 and ICD-10 codes.

There is still time to get ready!

Even though the October 1, 2015, mandatory implementation date is quickly approaching, providers still have time to prepare for ICD-10, and CMS has created a number of tools and resources to help you succeed. One tool is the “Road to 10,” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help you with implementation.

For more information