What is ICD-10-CM?
ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification), is a revision of ICD-9-CM, the current system used by healthcare providers to code or classify all diagnoses and symptoms.
When does ICD-10 begin?
The transition date for ICD-10 is October 1, 2015, in accordance to the Protecting Access to Medicare Act of 2014.
What is ICD-10-PCS?
ICD-10-PCS (International Classification of Diseases, 10th Edition, Procedure Coding System), is a revision of ICD-9-PCS, the current system used by healthcare facilities to code or classify all procedures or health interventions. ICD-10-PCS is only used by hospital facilities and is not utilized in conjunction with the capture or billing of physicians’ professional services.
Do all healthcare providers and payors have to transition to ICD-10?
All HIPAA-covered entities are required to transition to ICD-10. This includes healthcare providers, facilities, payors, clearing houses and vendors.
Non HIPAA-covered entities such as workers compensation or automobile insurance are not required to transition to ICD-10. However, CMS is urging the non-HIPAA entities to transition to ICD-10, not only for the benefits it provides, but in order to provide consistency among all documentation regarding patients’ care and treatment.
When do I have to begin using ICD-10 codes?
Use of ICD-10 is service-date driven – outpatient or professional claims with dates of services on or after October 1, 2015 must be coded using the ICD-10 code set.
Facility inpatient claims with discharge dates on or after October 1, 2015, must be coded using the ICD-10 code set.
Claims may not contain diagnoses in both ICD-9 and ICD-10 code sets. Claims may contain one — and only one — code set.
Will the date of service or the date of discharge determine which code to use?
All outpatient and professional claims with dates of service on or after October 1, 2015 must contain only ICD-10 diagnosis codes. Facility inpatient claims with discharge dates on or after October 1, 2015, must be coded in their entirety in ICD-10.
Do claims have to be split if the bill is submitted after October 1, 2015?
Yes. Payors will only accept one code set per claim, either all ICD-9 or all ICD-10, depending on the service date. If all claim dates of service are prior to the transition date, but the claim is submitted on or after October 1, 2015, ICD-9 should be used.
Can we submit bills coded in ICD-10 before October 1, 2015?
No. Current CMS guidelines require the use of ICD-9 codes until October 1, 2015. Use of ICD-10 for services provided prior to October 1, 2015 will violate existing guidelines and will be rejected.
What will happen if the bill has both ICD-9 and ICD-10 diagnosis codes?
Most major payors have indicated that they these claims will be rejected, meaning their systems will not even be able to accept claims with both code sets.