More on ICD-10 Implementation

Coding around the Compliance Date

A claim cannot contain both ICD-9 codes and ICD-10 codes:

  • For dates of service prior to October 1, submit claims with the appropriate ICD-9 codes, even if you submit the claim on or after the ICD-10 compliance date
  • For dates of service on or after October 1, 2015, submit with the appropriate ICD-10 codes

For hospital inpatient reporting, “date of service” is defined as date of discharge. Further guidance is available in MLN Matters® Article #SE1408.

What about Claims Spanning the Compliance Date? CMS has guidance for providers on claims that span the compliance date. See FAQ 12609.

Will CMS Allow for Dual Processing? CMS will not allow for dual processing of ICD-9 and ICD-10 codes. See FAQ 12430.

More information is available on the ICD-10-CM/PCS Frequently Asked Questions web page. For questions about commercial and other government insurance plans, please contact that plan.

Keep Up to Date on ICD-10 Visit the CMS ICD-10 website and for the latest news and resources, including the ICD-10 Quick Start Guide.

Physician Orders for Lab, Radiology Services, and Other Services after ICD-10 Implementation

CMS is not requiring the ordering provider to rewrite the original order with the appropriate ICD-10 code for lab, radiology services, or any other services after ICD-10 implementation on October 1, 2015, including Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

Products and services that require a diagnosis code on the order will use ICD-9-CM codes if written prior to October 1, 2015. If the order is for a repetitive service that will continue to be delivered and billed after October 1, 2015, providers have the option to use the General Equivalence Mappings (GEMs) posted on the 2016 ICD-10-CM and GEMs web page to translate the ICD-9-CM codes on the original order into ICD-10-CM diagnosis codes.

Access the ICD-10 Code Set

You can access complete versions of both ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) as well as the General Equivalence Mappings (GEMs) and Reimbursement Mappings on the 2016 ICD-10-CM and GEMs and 2016 ICD-10-PCS and GEMs web pages.

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