Split in two, except for inpatient codes ICD-10 Update on Claims and PAs That Span October 1

How will claims and prior approvals be submitted when the date of service begins before the October 1 implementation of ICD-10 and ends afterwards? We get that question often. The simple answer is to split them into two separate claims. For services before October 1, submit using ICD-9 codes. On October 1 and afterwards, use ICD-10 codes. In other words, where one claim or PA would have sufficed, now you will need two claims or PAs. This will require extra work for providers and payers alike, but it will only be for that one time.

The exception: Hospital inpatient claims. Inpatient claims with DRG pricing cannot be split. Instead, use the ICD code based on the discharge date. If the discharge date is September 30 or earlier, then hospitals will submit with ICD-9 codes. If the discharge date is October 1 or later, submit with ICD-10 codes.

NCTracks won’t accept ICD-9 codes with date of service starting October 1, per policy from the Center for Medicare and Medicaid Services (CMS). Most private payers also are using this process.