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April 2013
Reminder: Beginning April 1, use diagnosis code in place on date of discharge
As we told you last month, BCBSM has determined that we must change our facility guidelines for reporting diagnosis codes on inpatient claims. Effective April 1, 2013, we are asking our facilities to begin using the diagnosis code set in place on the date of discharge for inpatient claims.
Traditionally, BCBSM guidelines have asked our facilities to report the diagnosis code set on the date of admission.
This change not only meets the mandated requirement for the ICD-10 diagnosis code transition, but it also aligns our billing guidelines with those of other payers and makes us consistent with the Centers for Medicare & Medicaid Services.
Why make the change now?
Even though the ICD-10 implementation is scheduled for next year, we are making this change now to allow time for our facilities to make the necessary adjustments. In addition, the extra time allows BCBSM to ensure that our systems will be compliant with the ICD-10 mandate.
Examples of the change
To see how this change will impact you, check the chart below. Keep in mind that the ICD-10 transition date set by CMS is Oct. 1, 2014.
Date of patient discharge |
Code set being used by the industry when the patient is discharged |
What codes should appear on the inpatient claim |
April 1, 2013 |
ICD-9 |
ICD-9 |
Sept. 30, 2014 |
ICD-9 |
ICD-9 |
Oct. 1, 2014, and after |
ICD-10 |
ICD-10 |
For more information about billing, check your provider manual on web-DENIS. For more information about the ICD-10 transition, go to bcbsm.com/icd10.
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