All BOC Constituents,
As I am sure you are aware, on October 1, 2015, a new ICD-10 diagnosis code set will be adopted. I was pleased to accept BOC’s invitation to share how I have been preparing for the release of the new codes.
I know the correct use of ICD-9 vs ICD-10 codes can be confusing. Here is a quick summary of when each code is appropriate:
Use ICD-9 codes for claims with DOS1:
- Prior to October 1, 2015 (regardless of the date transmitted)
Use ICD-10 codes for claims with DOS:
- On or after October 1, 2015
Please note that using the incorrect code or both ICD-9 and ICD-10 codes in a single claim could result in the claim being denied or rejected.
This change will impact all of us. Expect delays in claim processing and/or increases in rejections and denials. My best advice is to be prepared. Here is what you can do to get ready:ICD-10 applies to all entities covered by HIPAA2. Even if you don’t accept Medicare or Medicaid, you will be required to process all claims as indicated above. This update does not affect CPT3 or HCPCS4 codes.
- Make sure your billing software is updated and compatible with ICD-10. Check with your software vendor and test it before October 1. Review this article for details on how to verify and test your software and systems.
- Check with your referral sources. Their billing software also should be updated and ICD-10-compatible. Verify that they will be using ICD-10 codes consistently throughout the treatment process. Each code must be an exact match to the related prescription.
- Prepare your practice for the cash flow setbacks that may follow this change. Do not allow unbilled claims to become back-logged.
Brad Watson, BOCO, BOCP
Secretary, Board of Directors
Board of Certification/Accreditation (BOC)
P.S. Multiple resources, including an ICD-10 Quick Start Guide are available at cms.gov/ICD10. You may also send your questions to BOC’s Regulatory & Legislative Analyst, Zack Chait, at email@example.com.
1. DOS: Dates of Service
2. HIPAA: Health Insurance Portability Accountability Act
3. CPT: Current Procedural Terminology
4. HCPCS: Healthcare Common Procedure Coding System