Use ICD-10 Now – Here’s How
On October 1 the United States health care community transitioned to ICD-10. CMS wants providers to be successful in using ICD-10 and remains committed to working with industry on the transition.
Coding Claims: When to Use ICD-10 versus ICD-9
Use of ICD-10 versus ICD-9 on claims is based on dates of service—not on dates that claims are submitted.
- For dates of service before October 1, 2015, use ICD-9 codes.
- For dates of service on or after October 1, 2015, use ICD-10 codes.
For example, if you submit a claim for services provided on September 30, 2015, use ICD-9, even if you are submitting the claim in October 2015 or beyond.
For hospital inpatient claims, use date of discharge rather than date of service to determine whether to code in ICD-10 or ICD-9.
Important Note About Physician’s Orders
For orders written with ICD-9 codes before October 1, 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. For more see the new Physician’s Orders FAQ 12625.
Many health plans require claims with dates of service spanning October 1 to be split into two claims, one with ICD-9 and the other with ICD-10 codes.
A Medicare fee-for-service (FFS) claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will not pay claims containing both ICD-9 and ICD-10 codes. CMS has issued guidance for providers dealing with claims spanning the compliance date.
See the ICD-10 Coding Resources fact sheet to find out about accessing ICD-10 codes, ICD-9/ICD-10 mappings, and clinical documentation tips.
- Find the latest resources at the official CMS ICD-10 website.
- Visit Roadto10.org to build a customizable action plan, and to see common codes, documentation tips and clinical scenarios for your specialty.
- Find additional ICD-10 resources at low or no cost through medical and trade associations.