Recent changes were made to the way that authorizations and referrals are processed in regards to ICD-9/ICD-10 coding. Please review the ICD-10 Quick Tips: Updated guidelines for submitting authorizations and referrals
page for more information.
On October 1, 2015, the United States will transition from ICD-9 to ICD-10 as the medical code set for medical diagnoses and inpatient hospital procedures. The transition to ICD-10 is not just an update but rather a complete overhaul. Our entire industry ? payers, providers, and vendors ? is affected by the transition to the expanded ICD-10 code set. These coding changes will affect medical coding operations, software systems, reporting, administration, registration, and more. Any delay could result in your office or organization experiencing backlogs, denials, and impacts on revenue.
As we rapidly approach the October 1, 2015, compliance deadline, we encourage you to plan ahead and be fully aware of all of the changes that will occur with the implementation of ICD-10. If you do not use valid ICD-10 codes for dates of service or dates of discharge on or after October 1, 2015, you will not be able to successfully bill for your services. Also note that our claims processing system will not accept both ICD-9 and ICD-10 codes on a single claim.
Now is the time to make sure your office is ICD-10 ready. The transition will go much more smoothly for organizations that have planned ahead. A successful transition to ICD-10 will be vital to transforming our nation?s health care system and ensuring uninterrupted operations.
Please also be aware that Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes will continue to be used for outpatient, ambulatory, and office-based procedure coding.
Claims for services that span the compliance date
Claims submitted for a date of service or date of discharge (for facility inpatient claims) on or after October 1, 2015, are required to be submitted with valid ICD-10 codes.
If your office submits an ICD-9 code on or after the October 1, 2015, compliance date, your claim will be denied and sent back to you for compliant coding. Providers should work with their trading partners, clearinghouses, and billing vendors/billing software companies to ensure ICD-10 compliance and avoid claims rejections, processing delays, and revenue impacts.
Additionally, all authorization and referral requests submitted prior to and including September 30, 2015, are required to use ICD-9 codes. All authorization and referral requests submitted on or after October 1, 2015, are required to use ICD-10 codes.
To help you prepare, we encourage you to take advantage of the resources available through Independence and the Centers for Medicare & Medicaid Services (CMS).
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After the October 1, 2015, compliance date, we encourage you to closely monitor your Health Care Claim Acknowledgement (277CA) transactions, Provider Explanation of Benefits (Provider EOB), and/or Provider Remittance to quickly identify and address coding issues related to ICD-10. If the incorrect code set is submitted after the compliance date, your claim will be denied and sent back to you for proper coding.