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WASHINGTON – While many in the industry liken the ICD-10 compliance deadline to flipping a switch, there will be a tricky subset of claims that “span the implementation date.”
Such claims will be the result of service performed and coded in ICD-9 on or prior to September 30, 2013 combined with care delivered after the October 1, 2013 compliance date – and thus coded as ICD-10.
To help providers understand and prepare for those situations, the Centers for Medicare and Medicaid Services (CMS) published a guide document on Friday.
In seven pages, Medicare FFS Claims Processing Guidance for Implementing ICD-10 (PDF), covers general reporting of ICD-10, claims submissions information and claims that span the ICD-10 implementation date – the latter garnering the lion’s share of the document.
“CMS has identified potential claims processing issues for institutional, professional and supplier claims that span the implementation date,” wrote CMS officials. “In some cases, depending upon the policies associated with those services, there cannot be a break in service or time, although the new ICD-10 code set must be effective October 1, 2013.”
CMS provided more than 20 examples of situations where using both ICD-9 and ICD-10 codes may be applicable.
The guide is the latest in a stream of ICD-10 resources CMS has provided. Last week, the agency posted widgets to help the spectrum of health entities understand the conversion timelines, and during the preceding week CMS tapped 3M for coding translation tools, a contract that also made the wares available to fiscal intermediaries, Medicare Administrative Contractors (MACs) and carriers.