LESS THAN 30 DAYS TO GO BEFORE THE ICD-10 COMPLIANCE DATE. STILL
HAVE QUESTIONS OR CONCERNS?
For small physician practices, http://www.roadto10.org is among your best resources for finding
answers to any final questions you may have regarding your transition to ICD-10.
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Use the ICD-10 Quick Start Guide (http://cdn.roadto10.org/wpuploads/2015/06/ICD10_Quick_Start_Guide.pdf) to:
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Obtain access to ICD-10 codes.
Identify the top ICD-10 codes most used by your practice.
Understand the role of your clearinghouse.
Obtain updated hard copy and electronic claims forms.
Access general training modules for you and your staff.
Test your systems and processes.
Find Specialty References including Family Practice, OB/GYN, Cardiology and 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 October 1,
2015, please:
Pay careful attention to your date of service. Claims for services occurring after October 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 ICD-9 codes for services rendered before October 1,
2015, and one claim with ICD-10 codes for services rendered after October 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.
Rejection advice on claims: If your claims are rejected, you will see the following advice on returned
claims reports from your clearinghouse:
ICD 10 rejection language.
ICD-9 indicator used; this is invalid for DOS on or after 10/1/15
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. Billing claims with unlisted,
unspecified or nonspecific codes should be avoided. Submitting accurately coded claims speeds
claims processing and helps reduce denials.
Guidance for dates of service and prior authorizations:
Type of service
Inpatient
Inpatient with known discharge date
Inpatient with unknown discharge date
Outpatient
Long-term outpatient
Begins
Ends
Prior authorization
Admission on or after
10/1/15
Prior authorizations must be requested with
Discharge on or after 10/1/15
ICD-10 codes.
Known discharge on or after
Prior authorizations must be requested with
Admission before 10/1/15
10/1/15
ICD-10 codes.
Prior authorizations must be requested with
Unknown at the time of admission
Admission before 10/1/15
ICD-9 codes. Prior-authorization would be
but discharge is on or after 10/1/15
valid for entire admission.
Prior authorizations must be requested with
Services on or after 10/1/15 Not applicable
ICD-10 codes.
Services beginning before
10/1/15
Services end on or after 10/1/15
Prior authorizations requested in ICD-9 will
be valid for services on or after 10/1/15.
AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast 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].