CMS lends ICD-10 transition hand

The Centers for Medicare & Medicaid Services (CMS) has released an ICD-10 transition guide. ICD-10 requirements go into effect Oct. 1, 2013.

According to the guide, ICD-10 is for all physicians, providers and suppliers submitting claims to Medicare contractors for services provided to Medicare beneficiaries.

On and after Oct. 13, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) will be required to use the ICD-10 code sets in standard transactions adopted under HIPAA, the guide stated. As a message to providers, the guide proclaimed, "Make sure your billing and coding staff are aware of these changes."

Providers and suppliers will still be required to report all characters of a valid ICD-10 code on claims as with ICD-9 codes currently. However, according to the guide, ICD-10 diagnosis codes have different rules regarding specificity and providers/suppliers are required to submit the most specific diagnosis codes based upon the information that is available at the time.

According to the guide, ICD-9 codes will no longer be accepted on claims with "FROM" dates of service or dates of discharge/through dates on or after Oct. 1, 2013. This includes such codes as split claims in inpatient Part B hospital services and split claims in outpatient hospitals. "Institutional claims containing ICD-9 codes for services on or after Oct. 13, 2013, will be returned to [the] provider," the guide noted.

Additionally, CMS has identified potential claims processing issues for institutional, professional and supplier claims that span the October implementation date; meaning where ICD-9 codes are effective for the portion of the services that were rendered on Sept. 30, 2013, and earlier and where ICD-10 codes are effective for the portion of the services that were rendered Oct. 1, 2013, and later.

"In some cases, depending upon the policies associated with those services, there cannot be a break in service or time (i.e., anesthesia) although the new ICD-10 code set must be used effective October 1, 2013," the guide read.

Included in the guide are sets of charts to provide guidance for claims spanning the periods where both ICD-9 and ICD-10 codes may be applicable.

Read the seven-page guide here.