FAQs re: ICD-10
This list reflects answers to frequently asked questions (FAQs) regarding ICD-10.
Note: The ICD-10 Crosswalk and Inbox referenced in these FAQs were discontinued on 12/31/15.
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1. Did CMS extend the October 1, 2014, ICD-10 implementation date?
Congress voted to extend the October 1, 2014 ICD-10 implementation date for one year. Covered entities should plan to complete the steps required to implement ICD-10-CM/PCS by no later than October 1, 2015.
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2. When will I be required to use ICD-10 codes?
ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2015.
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3. What are the requirements for use of ICD-10 codes?
You can view the CMS requirements online at http://www.cms.gov/ICD10.
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4. Why do we have to switch to ICD-10?
The Centers for Medicare and Medicaid Services (CMS) posted a final rule on August 24, 2012 that requires all HIPAA covered entities to adopt the ICD-10 code sets which replaces the ICD-9 code sets with a compliance date of October 1, 2015.
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5. Will ICD-10 replace CPT coding?
No. The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. ICD-10-PCS codes are for hospital inpatient procedures only.
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6. How does ICD-10 differ from ICD-9 ?
The new ICD-10 code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code. The terminology has been modernized and has been made consistent throughout the code set. There are also codes that are a combination of diagnoses and symptoms, so that fewer codes need to be reported to fully describe a condition.
Examples of the enhancements made with ICD-10 include:- It enables reporting of laterality (right vs. left designations), reflecting the importance of which side of the body or limb (e.g., left arm, left kidney, left eye) is the subject of the evaluation.
- It restructures reporting of obstetric diagnoses. In ICD-9-CM, the patient is classified by diagnosis in relation to the episode of care. In ICD-10-CM, the patient is classified by diagnosis in relation to the patient’s trimester of pregnancy.
More information will be available as we progress toward the implementation of ICD-10 on October 1, 2015.
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7. Is the use of ICD-10 based on date of service or date of billing?
Date of service. Claims for all health care services and hospital inpatient procedures performed on or after October 1, 2015, must use ICD-10 diagnosis and inpatient procedure codes. Claims for services provided before October 1, 2015, must use ICD-9 diagnosis and inpatient procedure codes.
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8. After October 1, can providers submit an X12 batch file of 837s containing claims with ICD9 codes and claims with ICD10 codes in the file?
Yes.
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9. Who has to transition to ICD-10?
All covered entities under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 must implement the new code sets by October 2015. Covered entities required to use the new code sets include health plans, payers, providers, clearinghouses, health care information system vendors, billing agents and other services.
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10. What happens if I don't switch to ICD-10?
For HIPAA-covered entities, failure to transition to ICD-10 is not an option. Without ICD-10, providers will experience delayed payments or even non-payment and a possible increase in rejected, denied or pended claims. Payments to providers cannot be made without the proper ICD-10 coding.
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11. What should providers do to prepare for the transition to ICD-10?
For providers who have not yet started to transition to ICD-10, below are actions steps to take now:
• Develop an implementation plan, communicate the new system changes to your organization, and ensure that leadership and staff understand the extent of the effort the ICD-10 transition requires.
• Secure a budget that accounts for software upgrades/software license costs, hardware procurement, staff training costs, work flow changes during and after implementation, and contingency planning.
• Talk with your payers, billing and IT staff, and vendors to confirm their readiness status.
• Coordinate your ICD-10 transition plans among your partners and evaluate contracts with payers and vendors for policy revisions, testing timelines, and costs related to the ICD-10 transition.
• Create and maintain a timeline that identifies tasks to be completed and crucial milestones/relationships, task owners, needed resources, and estimated start and end dates. -
12. What is the appropriate timeline to start ICD-10 training?
It is recommended that you should begin your staff’s ICD-10 training immediately. The transition to ICD-10 is a major undertaking for providers, payers and vendors. Training needs will vary by organization type, size and staff role. For example, physician practice coders will primarily need to learn ICD-10-CM diagnosis coding, while hospital coders will need to learn both ICD-10-CM diagnosis and ICD-10-PCS inpatient procedure coding.
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13. Is there a transition period when we can use either ICD-9 or ICD-10 codes?
No. If the date of service on a claim is before October 1, 2015, and contains ICD-9 codes, then the claim will be accepted for payment. If the date of service is on or after October 1, 2015, and uses ICD-9 codes, then this claim will be rejected. All claims that contain a date of service on or after the federally mandated compliance date of October 1, 2015, MUST use ICD-10 codes to be accepted for payment.
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14. At the point of transition to ICD-10, what will happen to claims in process with ICD-9 codes?
Claims with service dates prior to October 1, 2015 will continue to be processed with the ICD-9 codes.
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15. Will split billing be required? For example, if a patient is admitted on September 20, 2015, and discharged on October 5, 2015, will we have to do split billing?
If an inpatient claim has a discharge and/or through date of service on or after October 1, 2015, then the entire claim must be billed using ICD-10 codes. If an outpatient claim spans the compliance date, then it is recommended that the provider(s) split the claim so that all applicable ICD-9 codes remain on one claim with dates of service (DOS) through September 30, 2015, and all ICD-10 codes be placed on a separate claim with DOS starting on or after October 1, 2015.
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16. Can I still bill with ICD-9 codes after October 1, 2015?
Yes, but only for dates of service prior to October 1, 2015. ICD-9 codes must be used for dates of service prior to October 1, 2015 only.
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17. How long after the October 1, 2015, ICD-10 compliance date must I continue to report and/or process ICD-9 codes?
Claims for dates of service prior to October 1, 2015, must be submitted with ICD-9 codes, regardless of the date submitted. Given the timeframes allowed for timely filing of claims and subsequent adjustments, this could be an extended period of time.
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18. I'm a behavioral health service provider and use DSM-IV diagnosis codes. Do I have to convert to ICD-10?
Yes, behavioral health providers submitting diagnositic assessments and authorization request to the LME-MCOs or to Value Options for ages 0-3 or Health Choice, at some point in the determined near future by DHHS, will need to convert, over to DSM-5. Some private insurance carriers have already begun making these transitions. The U.S. Department of Health and Human Services has mandated all health organizations begin using the ICD-10 code set no later than October 1, 2015. DHHS is working to determine the best start date for the implementation of DSM5, and prior to October 1, 2015 of ICD-10.
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19. In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?
A DHHS workgroup consisting of staff from DMH/DD/SAS, DHB and DSOHF have been working together evaluating the changes that must be in place to ensure a smooth transition from DSM-IV-TR to DSM 5 for internal policy and practices. These changes would apply to clinicians who submit authorization request to provide services Medicaid recipients and / or State (DMHDDSAS) funded individuals. This workgroup has recently brought in additional members from the Council of Community Programs – Best Practice Standardization Committee members (consisting of LME-MCO, Provider and IT specialist representatives) to assist in this transition process and in determining a best start date for DSM-5 implementation. The goal of this work group has been to have implementation of DSM5 to happen months prior to the go live date of ICD-10. More information will be forth coming on this topic.
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20. Can you advise if North Carolina Medicaid is following the same guidance as CMS for claims that span the implementation period? Do claims need to be split as well as their prior authorizations (PAs)?
You are correct. Both claims and PAs will have to be split over the transition time. It will mean more work for both providers and payers, but it only happens over the October 1, 2015, implementation date and then going forward it will be easier.
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21. Can you please send me an example of a split claim to ensure I will be ready?
A split claim is really two separate claims. You submit a claim with dates of service before October 1 and another claim for dates of service on and after October 1. Usually you would have sent one claim, but this one time, you will need to send two claims. And the same is true for PAs. Remember, by federal mandate NCTracks cannot accept ICD-9 codes for dates of service on or after October 1, 2015.
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22. We want to participate in ICD-10 testing in NCTracks. How do we volunteer?
By this time, the providers who will be participating in ICD-10 testing with NCTracks have been selected and notified. We selected a limited number of providers representing a diversity of practices, specialties and facilities. These provider testers represent 80 percent of the claims submitted. We haven’t the bandwidth for every provider who offered to test. We hope to offer a limited testing tool for everyone this summer. In addition, there is an NCTracks ICD-10 Crosswalk at http://ncmmis.ncdhhs.gov/icdxwalk.asp. Note that new codes are being added regularly and some existing codes may change, so check back periodically. Between the crosswalk and this testing tool, we hope to make sure everyone is ready for ICD-10 in NCTracks.
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23. If I have a question about the NCTracks ICD-10 implementation, who do I ask?
From now until ICD-10 goes live in October, you can send your ICD-10 questions and comments to NCTracks-Questioner@dhhs.nc.gov. You will get an answer personally, and we will get an idea of the kinds of information you need. The best will be shared with everyone. We're all in this together.
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24. What is the soonest you will accept a claim with an ICD-10 code on it?
The federal government has mandated that October 1 is the earliest we can accept a claim with ICD-10 codes.
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25. If a date of service is prior to October 1, but the claim is not submitted until after October 1, which ICD codes should be used?
The codes to use will be based on date of service, no matter when you submit the claim. So if the date of service occurred before October 1, but you’re submitting the claim after October 1, you will use ICD-9 codes.
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26. The NCTracks ICD-10 crosswalk does not locate any of my codes. I tried searching common codes such as 401.9, 250.02, 250.00, 789.00.
Those codes are on the crosswalk, but as the directions state, you have to remove the decimal point. For example, enter ICD-9 code 707.10 as 70710. Once you do that, you will find the corresponding ICD-10 code.
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27. Will we be given a list of common codes for our specific discipline? I am a speech-language pathologist and use a limited number of codes. A master list which shows the ICD-9 codes converted to the new ICD-10 codes would be helpful. Will there be a resource for this?
You can find your codes on the NCTracks ICD-10 Crosswalk at http://ncmmis.ncdhhs.gov/icdxwalk.asp. Remember to enter your ICD-9 codes without a decimal and the crosswalk should tell you the corresponding ICD-10 codes.
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28. I work in a adult care home and used the crosswalk to find all of my diagnosis codes, but many have several ICD-10 codes that relate to the one ICD-9. For dates of service after October 1, do I just list all of the new ICD-10 codes?
No, you will have to select the single correct ICD-10 code or codes that best describes the patient’s diagnosis. If that code isn’t apparent to you, ask the referring physician. Of course, as now, some claims have more than one diagnosis code.
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29. Since we only provide one type of service (personal care), we only have one procedure code (99509). The crosswalk is not showing a match for this code. Could you provide the ICD-10 for 99509?
99509 is a CPT code, not an ICD-9 code. CPT codes are NOT changing as part of this ICD-10 implementation, so you will continue to use 99509 after October 1. The crosswalk is only for ICD-9 codes.
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30. From what I am gathering in all the information that you are sending out, these are only medical codes, correct? No dental codes involved.
You are correct. Most dental practices use ADA codes, not ICD codes. You can read about it here: https://nctracks.nc.gov/content/public/providers/ICD10/ICD10-announcements/Dental-Practices-and-ICD-10.html.
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31. Will there be an ICD 10 training held in Raleigh, NC?
Yes, virtually. Using ICD-10 codes on NCTracks requires only a 30-minute webinar course. For more information, see the July 28 announcement.
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32. After reading the emails and reviewing the resource sites for the switch to ICD-10 over the last several months, it seems like the codes being changed is the only real change that needs to be done to be able to file for services after October 1. Is this correct? It just seems a little too simple for the all build-up.
We salute you for being on top of the issue. The primary concern is to ensure that all aspects of the claim submission process – from business forms to practice management software to trading partners/billing agents – are ready to use ICD-10 codes, and to know which codes you should use. For help with the latter, see the NCTracks ICD-10 Crosswalk at ncmmis.ncdhhs.gov/icdxwalk.asp.
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33. Should DME and infusion claims that span across October 1 be split with dates prior to October 1 using ICD-9 codes and on October 1 and after using ICD-10 codes?
Yes, that is correct.
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34. If we have a signed MD document for start dates prior to October 1, we do not need to obtain a new document. Only when a recert is due or any new MD starts on October 1 and after will we use ICD-10 codes?
Yes, that is correct.
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35. And the same is true for prior approvals (PAs)? If we have an existing PA, we do not need to obtain a new one, but when a new PA is needed on or after October 1, we will use ICD-10 codes?
Yes, that is correct.
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36. As we dually code active patients that are on service before and after October 1, will the unspecified ICD-10 codes be acceptable?
Per DHB, yes.
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37. What is NCTracks doing to prepare for the amount of claims that will be split come the October 1 switch to ICD-10 codes?
Most claims are submitted as electronic X12 transactions to NCTracks, which are processed in near real time, as resources are available. In other words, the higher claim volume anticipated over the October 1 transition date will be queued up and processed as they are received. It may take somewhat longer to adjudicate the higher volume of claims. However, the NCTracks system is designed to accommodate fluctuations in claim volume. A normal checkwrite may vary from 2 million to as much as 7 million claims in a given week.
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38. Have these new ICD-10 codes been added into NCTracks?
The ICD-10 codes are in the NCTracks system, but federal rules for ICD-10 implementation will not allow ICD-10 codes to be used prior to October 1. NCTracks is actively engaged in testing with providers and trading partners through July. After that we will take any lessons learned from testing and make any changes needed. The ICD-10 codes will be available for use in the NCTracks system on October 1.
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39. Has NC Tracks tested with any clearinghouses? If so, which?
Yes, clearinghouses are participating in testing. They include ClaimLogic, ClaimRemedi, CPSI, MedAssets, Emdeon, HealthFusion, HIS, PHYSICIAN'S COMPUTER COMPANY, Relay Health, SSI Group, and Trizetto Provider Solution.
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40. When you speak of hospital inpatient claims being an exception to the rule of using split claims over the October 1 transition to ICD-10, does this exception apply to inpatient physician charges as well or just the hospital charges?
The exception to split claims only applies to the hospital charges, not physician charges. During the transition from ICD-9 to ICD-10 over October 1, hospital claims will be based on date of discharge, while physician/professional claims will be based on date of service, which means they must be split.
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41. You mentioned an additional ICD-10 testing tool that might be available this summer. I haven’t seen anything about it since then. Is it available at this time?
No, the testing product didn’t work well for North Carolina. At this point, there aren’t plans for more testing beyond the provider/trading partner testing currently underway.
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42. I am a billing agent for a dozen family care homes. Do my clients need to have their residents see a physician between now and October to provide the new ICD-10 code, or can we adjust the number accordingly per the original diagnosis?
No, the residents don't need to see a physician to get their new codes. See what their ICD-9 codes correspond to in ICD-10 codes using the NCTracks ICD-10 Crosswalk at http://ncmmis.ncdhhs.gov/icdxwalk.asp. You may find that there's a one-to-one match or that you can determine what the correct ICD-10 code would be for that resident. And if you can't, then you can call the physician's office and get their input.
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43. I'm sure I was told that dentists would not be required to use ICD-10 codes. Am I correct about that?
You’re correct in most cases. Most dental practices don’t have to worry about ICD-10. For the exceptions, see this brief article: https://www.nctracks.nc.gov/content/public/providers/ICD10/ICD10-announcements/Dental-Practices-and-ICD-10.html.
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44. We do PCS services and CAP. We only have two ICD codes that we use: S5125 and 99509. I cannot find where these codes have changed.
Neither of those codes are ICD-9 diagnosis codes. S5125 is a HCPCS code and 99509 is a CPT code and these codes will not change. (That’s why they’re not in the NCTracks ICD-10 Crosswalk.) For a short article on how to tell the difference between codes, see this: https://www.nctracks.nc.gov/content/public/providers/ICD10/ICD10-announcements/How-to-Recognize-an-ICD-Code.html.
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45. Is Medicaid going to require 3 codes for ABN external cause of injury?
NC Medicaid does not have any requirements for mandatory ICD-10-CM external cause code reporting.
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46. When is the first date of service that NCTracks will allow ICD-10 codes?
October 1, 2015
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47. When is the first date of service that NCTracks will require ICD-10 codes?
October 1, 2015
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48. Will the paper Remittance Advice (RA) be changing as a result of ICD-10?
Only as necessary to accommodate ICD-10 codes. Otherwise, the RA will be the same.
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49. Do NC local health departments or FQHCs fall into the category of providers that will not be penalized during the grace period?
There is no grace period for Medicaid. Only Medicare Part B claims are included. For more information, see the CMS Q&A.