Common ICD coding errors identified on paper and electronic claims

December 1, 2015

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Since the ICD-10 compliance date on October 1, 2015, Independence has noticed a number of common ICD coding errors that are affecting claims processing. 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:
    • – Outpatient claims. For dates of service on or before September 30, 2015, you must bill with ICD-9 codes. For dates of service on or after October 1, 2015, you must bill with ICD-10 codes.
    • – Inpatient claims. For dates of discharge on or before September 30, 2015, you must bill with ICD-9 codes. For dates of discharge on or after October 1, 2015, you must bill with ICD-10 codes.
  • DME and home infusion claims. 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 using are valid and appropriate.
For more information, visit our dedicated ICD-10 web page, which includes Frequently Asked Questions.

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