As you move along with your ICD-10 planning activities, you may have wondered how claims will be submitted around the time of the Oct. 1, 2014, transition deadline. For instance, how will you handle submission of a claim in October 2014 for a service you provided in September 2014?
Would you use ICD-9 or ICD-10 to code the diagnosis?
The Centers for Medicare & Medicaid Services (CMS), the federal agency overseeing the transition, provided the answer in a news update issued May 10:
Even if you submit your claim on or after the ICD-10 deadline, if the date of service was before the Oct. 1, 2014, deadline, you'll use ICD-9 to code the claim.
CMS advised that for dates of service on or after the Oct. 1 deadline, you will use ICD-10. However, you may not be able to use ICD-9 and ICD-10 codes on the same claim, based on your payer's instructions.
CMS further explained, "This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD-9 diagnosis codes for services provided before Oct. 1, 2014, and another claim with ICD-10 diagnosis codes for services provided on or after Oct. 1, 2014."
The agency said that some trading partners may request that ICD-9 and ICD-10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims, according to CMS.
Here's a hypothetical split-claim scenario:
A patient has an appointment on Sept. 27, 2014, and is diagnosed with bronchitis. He returns for a follow-up appointment on October 3, 2014. In this case, the practice will submit a claim with an ICD-9 diagnosis code for the first visit and another claim with an ICD-10 diagnosis code for the follow-up visit.
Check to make sure that your systems, third-party vendors, billing services and clearinghouses can handle both ICD-9 and ICD-10 codes for split claims following the Oct. 1, 2014 deadline.
Further information and resources can be found on CMS' ICD-10 website.
Note, too, that ICD-10 continuing education modules developed by CMS in partnership with Medscape are available here to help you prepare for the October 2014 deadline.