The ICD-10 Dilemma: To Split Claims or Not to Split Claims

As ICD-10 codes go into effect on Thursday, October 1, claims that span the ICD-10 implementation date for institutional, professional and supplier claims may need to be split. A split claim is actually two claims: one with ICD-9 codes for services provided prior to October 1 and another claim with ICD-10 codes for services provided on October 1 and afterwards.

Some exceptions:

·   Hospital inpatient codes are based on date of discharge

·   Durable Medical Equipment codes are based on the “From” date of service

·   Pharmacy claims are based on the prescription fill date

 

Generally speaking, NCTracks follows CMS guidelines. The chart in this CMS article lists what claims need to be split and which claims can be based on a single date:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1408.pdf

 

Additional information can be found in the “ICD-10 by Provider Type” fact sheets on the ICD-10 page of the NCTracks Provider Portal.

 

Time will solve this dilemma. Once the claims for services spanning the October 1 date have been adjudicated, then this won’t be an issue.