CMS provides guidance on claims bridging ICD-10 deadline

When the ICD-10 deadline arrives on Oct. 1, 2013, there will be some transitional issues involved in switching to the new diagnostic coding set. For example, some Medicare-covered services--such as hospitalization and home healthcare--may begin before the deadline and end after it.

Recognizing this elementary fact, the Centers for Medicare and Medicaid Services has published a guide document to help healthcare organizations deal with the transition. The Medicare FFS Claims Processing Guidance for Implementing ICD-10 encompasses the general reporting of ICD-10, information on how to submit claims, and claims involving dates of service that bridge the ICD-10 implementation date.

The guidance points out that Medicare will not process claims containing ICD-10 codes for services performed before Oct. 1, 2013, and it will not process claims with ICD-9 codes for services rendered on or after that date. The agency also will not process any claims with both types of codes on them. The message is unmistakable: Oct. 1 is the dividing line between the submission of ICD-9 and ICD-10 claims.

For claims that span the deadline, CMS provides a table that shows how healthcare institutions and professionals should address different kinds of situations. For example, when patients are admitted before Oct. 1 and discharged afterward, acute-care hospitals should bill the entire inpatient stay using ICD-10. But a physician who cares for a patient admitted before Oct. 1 and discharged afterward should submit two claims. The first claim, for services provided prior to the deadline, should use ICD-9 codes. The second claim, for services rendered on or after Oct. 1, should use ICD-10.

Among the other care settings cited in the guidance are outpatient hospitals, non-patient laboratory services, swing beds, skilled nursing facilities, home health care, rural health care clinics, dialysis clinics, federally qualified health clinics, outpatient therapy and rehab facilities, community mental health clinics, hospices, and critical access hospitals.

To learn more:
- read the guidance document (.pdf)
- see the Government Health IT article 

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