ICD-10 Frequently Asked Questions
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Who has to comply with ICD-10?
o ICD-10 will affect diagnosis and inpatient procedure
coding for everyone covered by the Health Insurance
Portability and Accountability Act (HIPAA), not just
those who submit Medicare or Medicaid claims.
Will ICD-10 codes be the only accepted codes starting on the compliance date of
October 1, 2015?
o ICD-10 CM codes will be required on all professional and outpatient claims with
dates of service on or after October 1, 2015, as established by the U.S.
Department of Health and Human Services. Both ICD-10 CM diagnosis and PCS
procedural codes will be required on all inpatient claims with service or
discharge dates on or after the compliance date of October 1, 2015. Service
dates or discharge dates prior to the established compliance date will require
ICD-9 codes.
Will HSC provide training for provider staff and/or providers?
o HSC will not be providing training to medical providers in the HSCSN network.
However, HSCSN has provided links to helpful websites that can give guidance
and help prepare them for impending changes. Providers should inquire about
training programs with organizations like AHIMA, AAPC, HIMSS, AHIP and others
to prepare for the conversion to ICD-10
How does implementation of ICD-10 impact the filing of paper claims?
o ICD-10 code set must be used on all claims – paper or electronic – with dates of
service on or after October 1, 2015.
Will CPT codes change or continue to be used as in the past?
o The use of CPT codes does not change and will be used on outpatient and
professional claims.
Who will be the primary contact at HSCSN for ICD-10?
o The primary contact is Ed Williams, Director of Provider Services. Ed’s email is
[email protected].
Can medical providers test with HSCSN prior to the ICD-10 compliance date?
o This is encouraged and will begin as early as July 15, 2015. Contact Ed Williams
for more information at [email protected].
Can I submit claims with ICD-10 codes prior to the October 1, 2015 implementation
date?
July 2015
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o No. Current CMS guidelines prohibit the use of ICD-10 codes prior to the October
1, 2015 effective date. Using ICD-10 for services/claims prior to October 1, 2015
will violate existing guidelines.
Can a claim contain both ICD-9-CM and ICD-10-CM/PCS codes?
o No. As required by CMS, only one code set per claim (i.e., all ICD-9 or all ICD-10).
We expect our claims to be billed or submitted to the same standard. Claims that
contain both ICD-9 and ICD-10 codes on or after October 1, 2015 will be rejected.
How will ICD-9 codes be disabled once ICD-10 CM and ICD-10 PCS code sets are in full
effect?
o Late filings and adjustments are to be expected for several months after October
1, 2015. Claims with ICD-9 codes with service or discharge dates before October
1, 2015 will be processed after that date according to timely filing and other
regular claims payment rules. Claims containing ICD-9 codes with a date of
service or discharge date of October 1, 2015 or later will be rejected. Any claim
being adjusted must be adjusted using the code set in which it was originally
filed.
July 2015