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April 2014
Here are answers to some frequently asked questions about ICD-10
By now, everyone knows that the federal government is requiring the health care industry to begin using ICD-10 codes in place of ICD-9 codes, beginning with dates of service Oct. 1, 2014.
For months now, BCBSM has been offering our health care providers information about the transition, seminars, conference calls and many other avenues of information to try and get the word out about this extremely important initiative.
Below we have collected some of the most common questions and answers that we receive about ICD-10 on a regular basis. We will continue to publish questions and answers, as well as other information about ICD-10, each month from now through the end of the year.
Typical ICD-10 questions
Q: When is implementation?
A: Oct. 1, 2014
Q: What billing information can you give me about ICD-10?
A: ICD-10 is based on the date of service.
- Dates of service before Oct. 1, 2014 would use ICD-9 codes and qualifiers.
- Dates of service on or after Oct. 1, 2014 would use ICD-10 codes and qualifiers.
- Dates of discharge for inpatient services on or after Oct. 1, 2014 would use ICD-10 codes.
- Billing date means nothing for use of these codes.
- Files can contain both claims with ICD-9 and ICD-10 claims.
- Individual claims cannot contain both ICD-9 and ICD-10 codes and qualifiers. This includes services that “span the ICD-10 implementation date.” This refers, for example, to a patient who is admitted to a hospital prior to the implementation date and is discharged after Oct. 1, 2014, when ICD-10 codes are in effect. BCBSM is following the Centers for Medicare and Medicaid Services guidelines when it comes to ICD-10 billing information. Look here** for more information about the CMS guidelines.
Q: What are the major changes for ICD-10?
A: The ICD-10 implementation affects diagnosis and inpatient procedure codes.
- ICD-10 does not affect CPT and HCPCS coding for outpatient procedures and physician services
- ICD-10 codes differ in length and structure from ICD-9 codes. (The maximum number of digits in ICD-10 is seven as opposed to five for ICD-9.)
- The code set contains more detail about conditions, injuries and illnesses.
- It includes the concept of laterality (codes for left and right side of body), combination codes (for conditions and associated symptoms) and uses updated language and terminology
- Approximately 150,000 ICD-10 codes replace 17,000 ICD-9 codes.
- Introduces the use of a seventh character encounter code for obstetrics, injuries and external causes of injuries.
Q: What happens if a provider does not switch to ICD-10?
A: Claims with dates of service on or after the Oct. 1, 2014, implementation date that do not use the appropriate ICD-10 code will be rejected in EDI front-end edits. Remember that claims for services provided before Oct. 1, 2014, must use ICD-9 diagnosis and inpatient procedure codes.
Q: Can a submitter send ICD-10 codes prior to Oct. 1, 2014?
A: No
Q: Can a submitter send both ICD-9 and ICD-10 codes on the same claim?
A: No
Q: Where can I get more information on ICD-10?
A: There are several sources for information, a few of the most common include:
Refer to previous issues of The Record for more information or go online to cms.gov/icd10** and bcbsm.com/icd10.
**BCBSM does not control this website or endorse its general content.
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