CMS ICD-10 Billing FAQs

ICD-10 billing

New ICD-10 Billing FAQs

On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. The Centers for Medicare & Medicaid (CMS) maintains a FAQ database on questions submitted for answers having to do with provider programs and policies. Here are new FAQs that have been posted on ICD-10 billing.

Question: How do I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2014 to on or after 10/1/2014?

Answer #8246: Many payers are requiring claims with dates of service that span the October 1, 2014 implementation date to be split so that the services prior to 10/1/2014 are billed separately and utilize ICD-9 codes; services on and after 10/1/2014 are billed separately and utilize ICD-10 codes. Link to ICD-10 Billing FAQ #8246.

Question: If I submit or process a transaction with an ICD-9 code for a date of service after October 1, 2014, am I HIPAA compliant?

Answer #8248: The date of service determines the compliant code format to be used in a claim regardless of the date the claim is filed or submitted. Providers will submit claims after October 1, 2014 with ICD-9 codes when the services were performed prior to October 1, 2014. Payers will process claims if received after October 1, 2014 with ICD-9 codes when the services were performed prior to October 1, 2014. This situation is HIPAA compliant. Link to ICD-10 Billing FAQ #8248.

Question: How long after the October 1, 2014 ICD-10 compliance date must I continue to report and/or process ICD-9 codes?

Answer #8252: Each payer determines their late filing requirements for standard transactions and ICD-10 does not require a change to these requirements. These deadline requirements vary among plans. Contact your payer for the current information regarding late filing for claims. Link to ICD-10 Billing FAQ #8252.

More ICD-10 resources from CMS: