As it is widely known, the movement towards ICD-10 code integration is an industry-mandated standard that is currently scheduled for implementation by October 1, 2015. Although these changes are subject to change, HEALTHCAREfirst will provide any pertinent information to clients as it becomes available. The following topics cover the changes made to Enterprise Edition for ICD-10, including general information and instructions for testing claims:
Additionally, guidelines regarding the submission of claims as well as additional ICD-10 resources have been included below:
General Claims Submission Information
The claim "thru" date will determine which ICD code is reported on a claim.
Episodes that are a full 60 days and begin on 8/3/2015, or later, will end on or after 10/1/2015.
As of 10/1/2015and beyond,ICD-9 codes will no longer be acceptedon claims (including electronic and paper) with "From" dates of service (on professional and supplier claims) or "Dates of Discharge / Thru" dates (on institutional claims).
For dates of service prior to 10/1/2015, submit claims with the appropriate ICD-9 code(s).
For dates of service on or after 10/1/2015, submit claims with the appropriate ICD-10 code(s).
All claims that have RTP (Returned to Provider) mustbe resubmitted with the appropriate ICD code(s).
Dual Coding and Billing Information
Dual-coding, or "crosswalking" patients (including both an ICD-9 code and corresponding ICD-10 code on the patient chart), will ensure that the correct code is available when bills are generated.
If an ICD-9 diagnosis code has a one-to-one match with the ICD-10 equivalent then the software will automatically select the ICD-10 code. If the ICD-9 code has multiple results as a match then the user will be responsible for selecting the correct ICD-10 code.
Some patients will require both an ICD-9 and ICD-10 code assigned totheir chart in Enterprise Editionso the software can correctly determine which code will be displayed on the claim.
Medicare will allow forno exceptionsfor submitting claims starting on 10/1/2015.
In general, Medicare will RTP all claims that are billed withbothICD-9 and ICD-10 codes (diagnosis or procedure/surgical) on the same claim. Although, our software will not allow this.
Some private payers (i.e. UnitedHealthcare, BlueCross BlueShield, Medicaid) may start using ICD-10 codeslater than10/1/2015; please contact these individual payers to obtain this information. Refer toICD-10 Override Datefor instructions on entering an override date for these payers.
The "crosswalk" feature will continue to function for agencies that need continued assistance in selecting associated ICD-10 codes due to training issues, etc.
Additional Resources
CMS also provides a variety of helpful information regarding ICD-10 at cms.gov/ICD10. One of which is a .pdf file that contains numerous links that each lead to different webpages regarding various aspects of ICD-10. These aspects include, but are not limited to:
Introduction to ICD-10
ICD-10 basics per level of care (Medical Practices, Rural Practices, Payers, Non-Covered Entities)
Communicating about ICD-10
"Road to 10" online resource
Ways to stay caught up with information regarding ICD-10
