Since the ICD-10 compliance date on October 1, 2015, AmeriHealth has noticed a number of common ICD coding errors that are affecting claims processing. Below you will find types of claim notifications and ICD-10 coding tips.

Claim notifications

Electronic claims submitters: If you submit claims electronically, you receive a Health Care Claim Acknowledgment (277CA) for notification of both accepted and rejected claims. It is important that this notification is regularly reviewed. The error description on the 277CA will aid you in correcting and resending files to ensure an expedited remittance. Providers should work with their clearinghouse/trading partner to ensure accurate claims submission.

Paper claims submitters: Providers who continue to submit paper claims will receive a claim return and cover sheet identifying the reason for claims rejection(s). Providers should respond to that notification accordingly and resubmit the corrected claim for processing.

ICD-10 coding tips

Please follow the tips below to ensure that your claims are coded correctly:

• Do not bill ICD-9 and ICD-10 codes on the same claim. Per guidelines from the Centers for Medicare & Medicaid Services (CMS), you cannot bill with both ICD-9 and ICD-10 codes on a single claim unless otherwise specified.
• Use the appropriate ICD code for inpatient and outpatient claims. For dates of discharge (inpatient) or service (outpatient) on or before September 30, 2015, you must bill with ICD-9 codes. For dates of discharge (inpatient) or service (outpatient) on or after October 1, 2015, you must bill with ICD-10 codes.
• Code DME and home infusion claims appropriately. Durable medical equipment (DME) and home infusion claims should be coded based on the ?From? date or initial date of service. If the ?From? date is on or before September 30, 2015, you must bill with ICD-9 codes. If the ?From? date is on or after October 1, 2015, you must bill with ICD-10 codes.
• Use the appropriate diagnosis qualifier:
  • Paper claims. When billing with ICD-9 codes, you must use the qualifier ?9?. When billing with ICD-10 codes, you must use the qualifier ?0? (CMS-1500, box 21; UB-04, field 66).
  • Electronic claims. Please refer to the most recent version of the HIPAA-mandated 5010 ASC X12 Implementation Guides for the 837I and 837P transactions.
• Use valid codes. Whether you are billing with ICD-9 or ICD-10 codes, please ensure that the codes you are usingare valid and appropriate.

For more information, including Frequently Asked Questions, visit our dedicated ICD-10 webpages for AmeriHealth New Jersey and for AmeriHealth Pennsylvania.