|
September 2015
Got questions about ICD-10? We’ve got answers
We’ve compiled a series of answers to some of the most frequently asked ICD 10-CM questions.
Do I have to use ICD-10-CM codes?
Yes. All providers need to start using ICD-10-CM diagnosis codes with dates of service Oct.1 2015, or later.
What are ICD-10-CM codes?
ICD-10-CM codes are replacing the ICD-9-CM diagnosis codes. As part of HIPAA guidelines, CMS has mandated the transition to ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes used by hospitals for inpatient surgical procedures.
When do I start using ICD-10 codes?
Start using ICD-10 codes for dates of service on or after Oct.1 2015.
How do I bill for multiple dates of services that span before and after Oct. 1, 2015?
- If you normally bill multiple dates of service on one claim and any of the dates of service are on or after Oct.1 2015, you must split the bill. Dates of service on or before Sept. 30, 2015, must use ICD-9 codes.
- There are some exceptions to this, depending on the provider type (such as DME providers) but for physicians, split billing is required.
- Click here** for CMS billing guidelines.
Can I start using ICD-10 codes before Oct.1 2015?
No. Claims with dates of service prior to Oct.1 2015, containing ICD-10 codes will be rejected.
Can I continue using ICD-9 codes after Sept. 30, 2015?
No. Any dates of service on or after Oct.1 2015, must have ICD-10 codes assigned.
ICD-9 codes will be used on claims with dates of service on or before Sept. 30, 2015, no matter when the claim is submitted.
Can I submit ICD-9 and ICD-10 codes on the same claim?
No. Claims with dates of service on or before Sept. 30, 2015, must be separate from claims with dates of service on or after Oct. 1, 2015.
Can I submit a file that contains both ICD-9 and ICD-10 codes?
Yes. The file can contain claims with both ICD-9 and ICD-10 codes, just not on the same claim.
If only one line on the claim is invalid or incorrect, will the one line reject or will the whole claim reject?
Professional claims are processed at the claim line level, so they will process at this level, which means just the one line would be rejected.
How descriptive are the claim rejection descriptions? Are they specific to the diagnostic code?
No. The rejection description will say if it’s an invalid code. There are several new Electronic Data Interchange edit messages related to ICD-10, See the July 2015 Record article titled “Correction: New edit codes to support ICD-10.”
I received edit codes that I have never seen before. What do these mean?
There are new edit codes related specifically to ICD-10 and the end-dating of all ICD-9 codes, See the July 2015 Record article titled “Correction: New edit codes to support ICD-10” for details on the following:
- MF20-MF26 relates to specific qualifiers and the need to report ICD-10 codes. (facility edit)
- F720-F729 relates to specific qualifiers that an ICD-9 code was reported after Oct. 1, 2015. (facility edit)
- F730-F740 relates to specific qualifiers that ICD-10 codes were submitted for dates of service prior to Oct. 1, 2015. (facility edit)
- F741-F743 other edits specific to the submission of ICD-9 or ICD-10 codes inappropriately. (facility edit)
- MP09-MP10 relates to specific qualifiers and the need to report ICD-10 codes. (professional edit)
- P943-P947 relates to specific qualifiers related to the date of service. (professional edit)
Do I need to start using ICD-10-PCS codes (procedure codes)?
ICD-10-PCS codes are used only by hospitals on inpatient claims with procedures.
HCPCS and CPT codes will continue to be used by physicians for billing procedures.
Will Blue Cross help me find the correct code for a condition?
We will not provide a mapping from an ICD-9 to an ICD-10 code or look up codes for you. Correct code selection is based on the documentation in the patient record.
Where can I obtain ICD-10 codes?
The codes are available from many sources and in many formats:
- Code books
- CD, DVD and other digital media
- Go to cms.gov/ICD10** and select 2016 ICD-10-CM and GEMS to download 2016 code tables and index.
- Practice management systems
- Electronic health record products
- Smartphone applications
Does ICD-10 apply to mental and behavioral health providers?
Yes. ICD-10 applies to all providers, including mental and behavioral health providers, and must be used to bill for services. (DSM-V code books include the corresponding ICD-10 codes.)
If the prescription was written prior to Oct. 1, 2015, and has an ICD-9 code on it and the script is brought into the pharmacy Oct. 1, what is expected of the pharmacy?
For submitting claims, the pharmacy is expected to translate the ICD-9 code to an ICD-10 code for prescriptions filled starting Oct. 1.
Will workers’ compensation agencies be ICD-10 compliant?
The State of Michigan’s workers’ compensation agency has confirmed they will be ICD-10 compliant for dates of service on and after Oct. 1, 2015.
With laterality included in ICD-10-CM, do we still need to report modifiers for left or LT, and right or RT?
Yes. The modifiers apply to CPT/HCPCS procedure codes that are not impacted by the transition to ICD-10-CM. Continue to follow the coding guidelines for these procedure code sets.
How do I report global procedure codes for prenatal care when the dates of service only span across the start date for ICD-10 of Oct. 1, 2015? (Procedure codes 59425 and 59426)
Enter date of first prenatal visit in the “From” field and last prenatal visit in the “To” field on the 1500 form. Report the diagnosis using the ICD code set, which is in effect for the date of service, in the “From” field. For example: If date of service is on or before Sept. 30, 2015, report ICD-9 codes. If date of service is on or after Oct. 1, 2015, report ICD-10 codes.
How do I report global maternity procedure codes for maternity care when the dates of service span across the start date for ICD-10 of Oct. 1, 2015?
Enter the date of the first prenatal visit in the “From” field and the date of the delivery in the “To” field. Report the diagnosis using the ICD code set, which is in effect for the date of service, in the “From” field. For example: If the date of service is on or before Sept. 30, 2015, report ICD-9 codes. If date of service is on or after Oct. 1, 2015, report ICD-10 codes. When reporting post partum care using procedure code 0503F, if the date of service is on or after Oct. 1, 2015, submit this code on a separate claim and use that date of service in the “From” field, using ICD-10 codes. Global maternity care includes antepartum care, delivery and postpartum care.
What is the replacement diagnosis for V67.2- follow-up exam following chemotherapy?
There is not a unique diagnosis code in ICD-10 for V67.2. Follow the official coding guidelines by reporting the code for encounter for chemotherapy as the first diagnosis when it’s the main reason the patient is being seen. This is code Z51.11 for encounter for antineoplastic chemotherapy. This code will establish that the patient is receiving a course of chemotherapy. Follow-up office visits apply to monitoring a course of chemotherapy. In addition, if the patient is experiencing complications that are caused by the chemotherapy, such as anemia, follow official coding guidelines and report the specific diagnosis code first, such as D64.81 for anemia to due antineoplastic chemotherapy.
What resources are available to assist me with ICD-10?
**Blue Cross Blue Shield of Michigan doesn’t own or control this website.
None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.
| 