Q: Why do we have to change from ICD-9 codes to ICD-10 codes?

A: The transition to ICD-10 is occurring because ICD-9 has limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

Q: Who needs to transition to ICD-10?

A: Health care providers, payers, clearinghouses and billing services (everyone covered by the Health Insurance Portability and Accountability Act must be prepared to comply with the transition to ICD-10. This is for all payers not just those who submit Medicare or Medicaid claims. The change to ICD-10 does not affect CPT® (Current Procedural Terminology) coding for outpatient procedures.

Q: Will CMS allow for dual coding (ICD-9 and ICD-10) starting Oct. 1, 2015?

A: The Centers for Medicare and Medicaid Services (CMS) states that ICD-9 codes will no longer be accepted on claims (including electronic and paper) with FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after Oct. 1, 2015. Institutional claims containing ICD-9 codes for services on or after Oct. 1, 2015, will be Returned to Provider (RTP) as unprocessable. Likewise, professional and supplier claims containing ICD-9 codes for dates of services on or after Oct. 1, 2015, will also be returned as unprocessable. You will be required to re-submit these claims with the appropriate ICD-10 code. A claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will RTP all claims that are billed with both ICD-9 and ICD-10 diagnosis codes on the same claim. For dates of service prior to Oct. 1, 2015, submit claims with the appropriate ICD-9 diagnosis code. For dates of service on or after Oct. 1, 2015, submit with the appropriate ICD-10 diagnosis code. Likewise, Medicare will also RTP all claims that are billed with both ICD-9 and ICD-10 procedure codes on the same claim. For claims with dates of service prior to Oct. 1, 2015, submit with the appropriate ICD-9 procedure code. For claims with dates of service on or after Oct. 1, 2015, submit with the appropriate ICD-10 procedure code. Remember that ICD-10 codes may only be used for services provided on or after Oct. 1, 2015. Institutional claims containing ICD-10 codes for services prior to Oct. 1, 2015, will be RTP. Likewise, professional and supplier claims containing ICD-10 codes for services prior to Oct. 1, 2015, will be returned as unprocessable. For more information, click here.

Q: How would our office file a claim if our patient is admitted to the hospital prior to Oct. 1, 2015 and is discharged after Oct. 2, 2015?

A: For Inpatient Part B Hospital Services CMS recommends filing Split Claims. Providers will be required to split the claim so all ICD-9 codes remain on one claim with Dates of Service (DOS) through Sept. 30, 2015, and all ICD-10 codes placed on the other claim with DOS beginning Oct. 1, 2015, and later. Outpatient hospital billing will following the same filing requirements.  For more information, click here.

For additional questions, reference CMS’ “ICD-10-CM/PCS Billing and Payment Frequently Asked Questions” Fact Sheet (ICN 908974).

ICD-10: What you need to know >>>