Blue Cross following CMS guidelines for ICD-10 billing information

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, 2015.

For months now, Blue Cross Blue Shield of Michigan has been offering our health care providers information about the transition through seminars, conference calls and many other avenues to spread the word about this extremely important initiative.

One of the most common questions we receive about billing for ICD-10 codes is: How will our billing guidelines compare to those from the Centers for Medicare and Medicaid Services?

Blue Cross will follow guidelines from CMS when it comes to billing ICD-10 codes. Those guidelines are found here.**

Below we’ve listed other common questions from health care providers about ICD-10 codes:

Frequently asked ICD-10 questions

Q: When is implementation?
A: Oct. 1, 2015

Q: When should I begin to use ICD-10 codes?
A: ICD-10 is based on the date of service.

• Dates of service before Oct. 1, 2015, would use ICD-9 codes and qualifiers.
• Dates of service on or after Oct. 1, 2015, would use ICD-10 codes and qualifiers.

Q: What are the major changes for ICD-10?
A: Some of the major changes are:

• The ICD-10 implementation affects diagnosis and inpatient procedure codes. (It does not affect CPT and HCPCS codes used 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 details 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.

• The ICD-10 implementation 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, 2015, implementation date that do not use the appropriate ICD-10 diagnosis or inpatient procedure code will be rejected in EDI front-end edits. Remember that claims for services provided before Oct. 1, 2015, must use ICD-9 diagnosis and inpatient procedure codes or they will be rejected in EDI front-end edits. A complete list of the EDI front-end edits were included in an article in the May Record.

Q: Can a submitter send ICD-10 codes prior to Oct. 1, 2015?
A: No, they cannot.

Q: Can a submitter send both ICD-9 and ICD-10 codes on the same claim?
A: No, they cannot.

Q: What about testing?
A: Blue Cross is also offering a medical scenario-based testing tool for professional health care providers. This web-based tool provides hand-on ICD-10 coding practices for different specialties. It is accessible through this link and will be available through Oct. 1, 2015. More information about the testing tool is available on bcbsm.com/icd10.

For more information, refer to previous issues of The Record or go to: roadto10.org,** cms.gov/icd10** and bcbsm.com/icd10.

**This website is cited for informational purposes only. Blue Cross Blue Shield of Michigan does not control this website or endorse its general content.