CMS Outlines ICD-10 Claim Submission Guidelines

Originally published in the July 1, 2015 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

In a MLN Matters article, the Centers for Medicare & Medicaid Services (CMS) offers claims processing guidance for implementing ICD-10 on Oct. 1, 2015. For claims with dates of service prior to Oct. 1, 2015, practices are reminded to submit claims and other transactions with the appropriate ICD-9 diagnosis code. For claims with dates of service on or after Oct. 1, 2015, these transactions are to be submitted with the appropriate ICD-10 code. As with ICD-9 codes today, practices will still be required to report all characters of a valid ICD-10 code on claims. CMS also states that ICD-10 diagnosis codes have different rules regarding specificity and providers are required to submit the most specific diagnosis codes based upon the information that is available at the time. In addition, the article includes dates of service guidelines for institutional and supplier claims as well as special outpatient claims processing circumstances. To assist practices with the ICD-10 transition, CMS has developed a five-step Quick Start resource.

Also access the MGMA member-benefit ICD-10 webinar and other ICD-10 resources.

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