October XX, 2015
READY FOR A SMOOTH TRANSITION
Avoid potential claim delays by understanding CMS ICD-10 claim-splitting
guidelines.
Select Health of South Carolina is distributing this communication to clarify any
confusion caused by CMS claim-splitting guidelines and plan-specific communications.
Select Health will align with the CMS-issued revised Claims Processing Guidance for
Implementing International Classification of Diseases, 10th Edition (ICD-10), which is
dated June 27, 2015. This revised CMS guideline document outlines the following claim
guidelines:
Bill
Type
Facility
Type/Service
Claims Processing Requirement
11X
Inpatient
Hospitals
If the hospital claim has a discharge and/or through date on
or after 10/1/15, then the entire claim is billed using ICD-10.
12X
Inpatient Part B
Hospital Services
Split Claims - Providers must split the claim so all ICD-9
codes with dates of service (DOS) through 9/30/2015 are on
one claim and all ICD-10 codes with DOS beginning
10/1/2015 and later are on another claim.
13X
Outpatient
Hospital
Split Claims - Providers must split the claim so all ICD-9
codes with DOS through 9/30/2015 are on one claim and all
ICD-10 codes with DOS beginning 10/1/2015 and later are on
another claim.
4X
Non-Patient Lab
Services
Split Claims - Providers must split the claim so all ICD-9
codes with DOS through 9/30/2015 are on one claim and all
ICD-10 codes with DOS beginning 10/1/2015 and later are on
another claim.
18X
Swing Beds
If the [Swing bed or SNF] claim has a discharge and/or
through date on or after 10/1/2015, then the entire claim is
billed using ICD-10.
FC-10092015-P-004 │ ICD-10 Split Claims
Need more information?
The CMS guideline document contains guidelines about additional bill type and
scenarios relating to claims splitting surrounding the ICD-10 implementation date of
Oct. 1, 2015. For more information regarding the guidelines, please visit the CMS
website or access the revised guidelines at the following link:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/SE1408.pdf
CMS’s “Road to 10” online resource (www.roadto10.org) can help smaller practices
build action plans as well as provide common codes and resources for primary care
and specialty physicians.
We will continue to share with you ICD-10 educational materials, tools and resources.