LESS THAN 30 DAYS TO GO BEFORE THE ICD-10 COMPLIANCE DATE.
STILL HAVE QUESTIONS OR CONCERNS?
For small physician practices, www.roadto10.org is among your best resources for finding
answers to any final questions about your transition to ICD-10.
•
Use the ICD-10 Quick Start Guide (http://cdn.roadto10.org/wpuploads/2015/06/ICD10_Quick_Start_Guide.pdf) to:
o Obtain access to ICD-10 codes.
o Identify the top ICD-10 codes most used by your practice.
o Understand the role of your clearinghouse.
o Obtain updated hard copy and electronic claims forms.
o Access general training modules for you and your staff.
o Test your systems and processes.
•
Find Specialty References including family practice, OB/GYN, cardiology, pediatrics
and more. These clinical concept guides include:
o Common ICD-10 codes associated with your specialty.
o ICD-10 clinical interactive tools with scenarios that help illustrate the level
of specificity required when coding claims.
o Training and educational resources related to your specialty for you and
your staff.
o Guidance for building an action plan.
For additional information, tools and resources, continue to reference the CMS dedicated
website: www.cms.gov/ICD10.
To ensure your claims are processed timely and accurately after Oct. 1, 2015, please:
Pay careful attention to your date of service. Claims for services occurring after
Oct. 1, 2015, will need to be coded with ICD-10 codes. Claims that span the
implementation date will need to be submitted on two claims — one claim with ICD9 codes for services rendered before Oct. 1, 2015, and one claim with ICD-10 codes
for services rendered after Oct. 1, 2015. Claims submitted with incorrect coding will
be rejected. They will not be recorded in our system and will be returned to you to
be resubmitted as a new claim with the appropriate diagnosis codes.
ICD 10 rejection language: If your claims are rejected, you will see the following language
on returned claims reports from your clearinghouse:
ICD-9 indicator used; this is invalid for DOS on or after 10/1/15
FC-09102015-P-004 │ ICD-10
ICD-9 diagnosis code used on line %LINE% is invalid for DOS on or after 10/1/2015
ICD9 and ICD10 diagnosis codes cannot be billed on the same claim
Bill with the highest level of specificity. To align with the specificity of ICD-10, remember
that CPT/HCPCS codes should be coded to the highest level of specificity. Avoid billing
claims with unlisted, unspecified or nonspecific codes. Submitting accurately coded claims
speeds claims processing and helps reduce denials.
Guidance for dates of service and prior authorizations:
Type of service
Begins
Ends
Prior authorization
Inpatient
Admission on
or after
10/1/15
Inpatient with known
discharge date
Prior authorizations must
Admission
Known discharge on
be requested with ICD-10
before 10/1/15 or after 10/1/15
codes.
Inpatient with unknown
discharge date
Unknown at the time
Admission
of admission but
before 10/1/15 discharge is on or
after 10/1/15
Prior authorizations must
be requested with ICD-9
codes. Priorauthorization would be
valid for entire
admission.
Outpatient
Services on or
after 10/1/15
Prior authorizations must
be requested with ICD-10
codes.
Long-term outpatient
Services
Services end on or
beginning
after 10/1/15
before 10/1/15
Prior authorizations must
Discharge on or after
be requested with ICD-10
10/1/15
codes.
Not applicable
Prior authorizations
requested in ICD-9 will be
valid for services on or
after 10/1/15.
Thank you for your continued efforts towards ICD-10 readiness. We are pleased to partner
with you as we move toward a successful transition to the ICD-10 coding set. If you have
additional questions or concerns, please contact the ICD-10 Testing team at
[email protected].