Insurance coding statement

Four Additional ICD-10 Coding Tips

Building on a recent ICD-10 coding post, Mary Bort, Director of Coding at Surgical Notes, MDP, LP, and Regent RCM coding partner, shares four more coding tips aimed at helping ASCs succeed while implementing new ICD-10 codes.

  1. Claim Rejection for CMS

The procedures for correcting and resubmitting rejected claims and issues related to denied claims have not changed with ICD-10, so submitters should follow their existing billing procedures. CMS will not reject claims because of lack of specificity required for a National Coverage Determination (NCD), Local Coverage Determination (LCD) or other claim edit.

  1. Dates of Service

For outpatient and physician reporting, the proper CPT code set is driven by the date of service, NOT by the billing date. Claims for dates of service on and subsequent to October 1, 2015 must be coded in ICD-10. Claims for dates of service prior to October 1, 2015 must be coded in ICD-9 – any claims for dates of service after October 1, 2015 that contain ICD-9 codes will be rejected. There is no dual code reporting, so claims cannot contain both ICD-9 and ICD-10 codes.

  1. HIPAA (Health Insurance Portability and Accountability Act of 1996)

While HIPAA covered entities are required to accept ICD-10 codes as of October 1, 2015, entities that are not covered under HIPAA are NOT required to accept ICD-10 codes.

Covered Under HIPAA:

  • CMS
  • Commercial payers such as Aetna, BCBS and United Healthcare
  • Federal payers such as Medicaid

Not covered under HIPAA:

  • Attorneys
  • Lien companies
  • Workers compensation carriers
  • Auto insurance

NOTE: According to iHeathBeat, California, Maryland, Louisiana and Montana will continue to use ICD-9 for Medicaid fee-for-service programs – Medicare has approved a delay for those state Medicaid programs due to inability to process ICD-10 codes. Other carriers will have to adhere to the rules if they are a HIPAA covered entity, regardless of the state.

  1. Types of Testing

If a center has not yet performed ICD-10 testing, it should perform content-based testing, internal, and external testing. Content-based testing can identify gaps in a center’s ICD-10 upgrades and should be performed to assess surgeons’ documentation and coders’ ability to code in ICD-10. Internal testing should be conducted to evaluate a practice’s ability to create and use ICD-10 codes throughout the patient workflow in place of ICD-9 codes. External testing should be performed with internal trading partners, such as billing service, clearinghouse and payers, to test a center’s ability to send and receive transactions that use ICD-10 testing. This will include acknowledgement testing and end-to-end testing.

The rapidly changing health care market presents both challenges and opportunities. Partners like Regent RCM and Surgical Notes can provide customized solutions and streamlined processes. Click here to contact Regent RCM and connect with an RCM expert or click here to contact Surgical Notes for coding or transcription specific questions.

Ed Tschan, Regent RCM Director of Business Development,

Don Callender, Surgical Notes, Central Region Sales Director,