The current Center of Medicare & Medicaid Services (CMS) ICD-10 compliance date is October 1, 2015. As of October 1, we will be ready to accept ICD-10 codes on claims based on dates of service (outpatient) or dates of discharge (inpatient). The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
Providers will be required to submit Health Insurance Portability and Accountability Act (HIPAA)-compliant transactions in version 5010. As of October 1, all HIPAA-covered entities must use the new ICD-10 code sets.
The current ICD-9 code sets are out-of-date due to their limited ability to accommodate new procedures and diagnoses. ICD-10 incorporates greater specificity of codes - more clinical information contained in the codes - and updated terminology.
Use of ICD-10 will:
- Improve the ability to measure health care services
- Enhance the ability to monitor the populations' health
- Provide better overall data and decrease the need for supporting documentation needed when submitting claims
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If you are interested in ICD-10 testing with our health plan, please send us your practice contact information using this form and you will be contacted with updates.
What is ICD-10?
Effective October 1, 2015, all health care entities must use ICD-10 codes on HIPAA transactions, including:
- Diagnosis codes (ICD-10-CM) used by all providers in every health care setting
- Procedure codes (ICD-10-PCS) only used for hospital claims and inpatient hospital procedures
What are the effective dates?
After October 1, 2015, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to the October 1 compliance date.
What is different?
ICD-10 codes length and structure differ from ICD-9 codes. In addition, ICD-10 codes:
- Contain more detail about conditions, injuries and illnesses
- Include the concept of laterality
- Use combination codes to describe conditions and associated symptoms
- Use updated language and terminology
Will the ICD Indicator be required on paper claim submissions?
Yes. With the upcoming implementation of the ICD-10 mandate, the use of ICD indicators will be required on all paper claims (UB-04 and CMS-1500) submitted on or after September 26, 2015. This requirement is based on the date of claim submission rather than date of service. You may start billing with the ICD indicator effective immediately, and we strongly recommend that you update your system to use the indicator prior to September 26. In the ICD indicator field on the claim form, located in box 21 of the 02/12 version of CMS-1500, and box 66 of the UB-04, enter the number "0" to indicate ICD-10 or "9" to indicate ICD-9. Effective September 26, claims submitted without ICD indicators or with invalid ICD indicators will be rejected with a message stating that the ICD indicator is required.
CMS recently stated that they will allow for one year leniency. What does this mean?
On July 6, 2015, CMS and the American Medical Association announced that there will be some leniency in the processing of ICD-10 codes for the first year beyond the October 1, 2015, compliance date. Stating "for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule…based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family."
CMS has since clarified its joint announcement reiterated that leniency in no way signifies another ICD-10 delay, and that 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. To learn more, access CMS' clarifying FAQs
As a reminder, our health plan will follow the coding guidelines as defined by the CMS mandate based on the time frame defined by the mandate, and we will require coding specificity within the family group to ensure appropriate claims payment.
How do I prepare?
- Learn about the structure and differences of the ICD-10 code set
- Look at your organization and see what it will take to make the change
- Train coders on ICD-10 prior to October 1, 2015 Talk with your vendors, payers, clearinghouses, billing services about ICD-10 readiness
- If you have not already started to prepare it is important that you start now!
- Review the resources and tools on the CMS website (http://www.cms.gov/ICD10/) to help ensure a smooth transition.
What is our health plan’s position on ICD-10 implementation?
- We have remediated all of our systems to be ICD-10 compliant. ICD-10 testing with our providers is underway and will continue through the beginning of September 2015.
- If you are interested in testing with our health plan, please send us your practice contact information using this form and you will be contacted with updates. Please do not include any other confidential information in this request.
- Follow this link to learn more about our position on ICD-10 implementation (PDF).