As of Oct. 1, 2013, claims submitted in the United States must use ICD-10 codes and insurers will reject claims with ICD-9 codes. So what happens if a claim for treatment crosses the ICD-10 implementation date, with ICD-9 codes effective for services on Sept. 30 and earlier, and ICD-10 codes effective starting Oct. 1?

That's the subject of new guidance from the Centers for Medicare and Medicaid Services on its Medicare Learning Network Web site at "In some cases, depending on the policies associated with those services, there cannot be a break in service or time (i.e., anesthesia) although the new ICD-10 codes set must be used effective October 1, 2013," CMS notes in the guidance.

The guidance, for Medicare payments, walks through various requirements and scenarios for coding treatment during the transition period. For instance, if a hospital claim has a discharge and/or through date on or after Oct. 1, then the entire claim is billed using ICD-10. Anesthesia procedures that begin on Sept. 30 but end on Oct. 1 are to be billed using ICD-9 diagnosis codes and use Sept. 30 as both the "From" and "Through" date.

For inpatient Part B hospital and outpatient hospital services, providers must split the claim so all ICD-9 codes are on one claim and all ICD-10 codes are on another claim. There's also guidance on coding for non-patient lab services, swing beds, skilled nursing facilities, critical access hospitals, durable medical equipment, hospice, home health, rural health clinics, and multiple other facility types and services.

Transmittal R9500TN, "Medicare Fee-For-Service Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition," is available here.


Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access