CMS: How to Process Claims When ICD-9, ICD-10 Codes Both Apply

CMS has identified potential claims processing issues that span the ICD-10 implementation date, or when ICD-9 and ICD-10 codes may both apply, according to a Medicare Learning Network Matters report (pdf).

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According to the report, there are four types of claims where this issue could arise: institutional providers (e.g., inpatient hospitals), special outpatient claims processing circumstances, professional claims and supplier claims. For example, if an inpatient hospital claim has a discharge and/or through date that is on or after Oct. 1, 2013 — the implementation date for ICD-10 — then the entire claim is billed using ICD-10, and providers should use the “through” date.

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