In a nutshell, ICD-10-CM replaces ICD-9-CM for diagnosis coding in all health care settings, and ICD-10-PCS replaces ICD-9-CM for inpatient procedure coding. As with ICD-9, outpatient ICD-10 coding is based on date of service; inpatient ICD-10 coding is based on date of discharge. Use of other codes, such as Current Procedural Terminology (CPT®), HCPCS and Revenue Codes is not impacted by the transition to ICD-10.
A sampling of frequently asked questions, with answers from Blue Cross and Blue Shield of New Mexico (BCBSNM), is included below for your convenience. For additional questions and answers, refer to our ICD-10 Provider FAQs.
1. When are ICD-10 codes required on claims?
ICD-10 codes must be used on all claims – paper or electronic – with dates of service on or after Oct. 1, 2015, and inpatient institutional claims with a date of discharge on or after Oct. 1, 2015. The media (paper or electronic) used to submit the claim does not affect the code set used on the claim. As of the Oct. 1, 2015, compliance deadline, claims without valid ICD-10 codes, as required, will not be accepted by BCBSNM.
2. Is ICD-10 required on other transactions besides claims?
Yes, ICD-10 codes must also be used on other transactions, such as, benefit prior authorization requests. BCBSNM began accepting ICD-10 codes as of Sept. 21, 2015, for benefit prior authorization requests for services to be rendered on or after Oct. 1, 2015. Prior to submitting a benefit prior authorization request, we encourage you to check eligibility and benefits through your preferred online vendor portal.
3. Are there any special considerations when submitting ICD-10 on electronic claims?
There are indicators to specify if the code that follows is ICD-9 or ICD-10. Your electronic trading partner(s) (practice management software vendor, billing service and/or clearinghouse) should be aware of this change.
4. Could claims coded in ICD-10 be submitted before Oct. 1, 2015?
No. Current federal regulations required the use of ICD-9 codes for dates of service through Sept. 30, 2015. Providers were instructed to begin using ICD-10 codes on or after Oct. 1, 2015 for claims with dates of service Oct. 1, 2015, and later.
5. Do I split a claim if it's submitted after Oct. 1, 2015, and the dates of service span the compliance date?
CMS has clarified that only one code set per claim is allowed; i.e., all ICD-9 or all ICD-10. Claims will be returned if they contain both ICD-9 and ICD-10 codes. Depending on the type of claim (e.g., inpatient institutional, facility outpatient, or professional), there are different rules for how to code a claim with dates of service that span the ICD-10 compliance date.
6. How will ICD-9 codes be disabled once ICD-10-CM and ICD-10-PCS are in full effect?
BCBSNM expects there will be late filings and adjustments for several months after Oct. 1, 2015, for claims incurred before that date. We will continue to accept ICD-9 for dates of service Sept. 30, 2015, and earlier. Claims containing ICD-9 codes with a date of service or inpatient discharge date of Oct. 1, 2015, or later will be returned. An adjusted claim must be submitted using the code set in which it was originally filed.
7. I need to resubmit a claim after the compliance date that was correctly coded in ICD-9. Do I need to convert to ICD-10?
Use of ICD-10 is service-date driven. Inpatient institutional claims with discharge dates on or after Oct. 1, 2015, and outpatient or professional claims with dates of services on or after Oct. 1, 2015, must be coded using ICD-10 codes. Resubmissions or adjustments to previously filed claims must be submitted in the same code set used in the originally submitted claim.
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