Preparing physicians for ICD-10: Split claims, CMS testing, and more solutions

Renee StantzQ: We understand that, at this point, the October 1, 2014, deadline for ICD-10 transition is firm. If we have a date of service in September 2014, but the claim isn’t billed until October 2014, which codes do we use, ICD-9 or ICD-10?

A: Your date of service determines which code set to use.  In your example, even if you submit your claim on or after October 1, 2014, if the date of service is before the October 1, 2014, deadline, you will use the ICD-9 Clinical Modification (ICD-9-CM) diagnosis code set for the claim.

On the other hand, for dates of service on or after the October 1, 2014, deadline, you will use the ICD-10 codes. If you have multiple line items on one claim, with dates of service that are before and after the October 1, 2014, deadline, you may have to split those into two claims:  one claim utilizing ICD-9 diagnosis codes for dates of service provided before October 1, 2014, and another claim using ICD-10 diagnosis codes for dates of service on or after October 1, 2014.  You should check with each of your payers and understand their specific instructions.

Some trading partners may request that ICD-9 and ICD-10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims.

Example of a split claim

Here’s an example of a split claim:  A patient has an appointment on September 27, 2014, and is diagnosed with simple chronic bronchitis. He returns for a follow-up appointment on October 3, 2014. In this case, a practice will submit a claim based on documentation as follows:

• September 27, 2014: Use ICD-9 (491.0 Simple chronic bronchitis)

• October 3, 2014: Use ICD-10 (J41.0 Simple chronic bronchitis)

Is your vendor prepared?

Since you will be utilizing both ICD-9 and ICD-10 codes until all of your September 2014 claims are submitted, make sure that your systems, third-party vendors, billing services, and clearinghouses can handle both ICD-9 and ICD-10 codes.

Ask your vendors the following questions:

• What are your instructions in regard to ICD-9 and ICD-10 coding for submitting a claim for dates of service prior to October 1, 2014, and after October 1, 2014?

• What are your instructions in regard to ICD-9 and ICD-10 coding for a continued hospital stay where a patient is admitted on September 27, 2014 and discharged on October 3, 2014?

• How long will your system accept ICD-9 codes after October 1, 2014?

• When reviewing my medical record, will you translate ICD-9 and ICD-10 for appropriate review?

• How long will I be able to appeal a record containing an ICD-9 code?

All offices need to be prepared, as the Centers for Medicare and Medicaid Services has given no indication that they are pushing back the October 1, 2014 deadline. So take appropriate steps now.

Q: Will there be Current Procedural Terminology (CPT) code updates As a result of  ICD-10 being rolled out this year?

A: While there are going to be minimal changes to the ICD-9-CM codes in 2014, there are a number of changes to the Current Procedural Terminology (CPT) codes. 

Remember that International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) does not affect CPT codes, so the code “freeze” in 2014 is for ICD-9 codes only.

The 2014 CPT Manual will include a total of 329 changes, including  175 new codes, 107 code descriptor revisions, and 47 CPT code deletions.

CPT Changes

The following are the highlights:

E/M codes: There will be four new Evaluation and Management (E/M) codes for interprofessional telephonic/internet assessment and management services.

Cardiology: The cardiology section will include 19 new cardiology procedures, including five new peripheral stenting codes, eight new CPT codes for fenestrated endovascular aorta repair (FEVAR), and four new CPT for vascular embolization or occlusion.

Gastro: The gastrointestinal section has the most changes, which include 26 new endoscopy codes, more than 40 revisions to code descriptors, and multiple deleted codes.

Elbow/Shoulder: The elbow and shoulder prosthesis section is reorganized in the musculoskeletal chapter.  Additionally, three new codes are added to distinguish foreign body removal from removal of a prosthesis.

Nervous System: The Nervous System section includes eight new codes that will replace the chemodenervation codes. 

Integumentary: In the Integumentary System section, a new code has been added for image guided fluid collection, drainage of a catheter. 

This new code will replace several throughout the 2014 CPT book. 

Breast: In addition, 14 codes will be added for new biopsy codes in the Breast section.

Q: We heard medicare would not perform ICD-10 claim testing, but now we hear they will test claims. Can you provide any information to clear up this confusion?

A: Due to the recent issues surrounding the implementation of Healthcare.gov, the Centers for Medicare and Medicaid Services (CMS) has reversed its decision to test claims.  According to MLN Matters® MM8465, CMS will conduct a national ICD-10 code set testing week, March 3 through March 7, 2014, for current direct submitters (providers and clearinghouses).

The testing week will help you prepare for the ICD-10 transition by giving trading partners access to the Medicare Administrative Contractors (MACs) and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support.

The event will be conducted virtually, and registration is required.  You should contact your local carrier for specific information regarding registration.

Breaking down the process of claims testing

Here’s what you can expect during testing:

• Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2013 through March 3, 2014), since testing does not support future dated claims;

• Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system;

• Testing will not confirm claim payment or produce remittance advice; and MACs and CEDI will be staffed to handle increased call volume during this week.

Contact your vendors to ensure that they will be ready for CMS testing week.

Answers to readers' questions were provided by Renee Stantz, a billing and coding consultant with VEI Consulting Services in Indianapolis, Indiana. Send your ICD-10 and coding questions to medec@advanstar.com.

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