What is ICD-10? ICD-10 is the 10th revision of the International Classification of Diseases (ICD). ICD is used to report by code a range of medical diagnoses and inpatient procedures. ICD-10 will replace ICD-9. This transition is being mandated by the Centers for Medicare and Medicaid Services (CMS) because the current ICD-9 system is outdated and has not kept up with current medical practice. ICD-10 also allows for more flexibility in creating new codes for new procedures.
When is ICD-10 going to be implemented? ICD-10 implementation is scheduled for October 1, 2015. At this time we are working toward system readiness.
How does this change affect me? This change will affect your claims that have a date of service on or after October 1, 2015. All claims submitted with a date of service on or after October 1, 2015 will require an ICD-10 diagnosis code. Please note that any claim submitted with an ICD-9 diagnosis code for dates of service on or after October 1, 2015 will be denied for invalid diagnosis code. ICD-9 diagnosis codes should continue to be used on all claims with dates of service before October 1, 2015. This is consistent with CMS Guidelines.
Who at Colorado Access can answer my questions about the ICD-10 transition? For specific questions as it pertains to Colorado Access, providers can contact their assigned provider representative. We encourage you to check the CMS website (cms.gov/ICD10) often.
Are you prepared to meet the October 1, 2015 ICD-10 deadline? Yes, we are prepared to meet the October 1, 2015 ICD-10 deadline. We encourage all of our providers and trading partners to get ready too. If you have specific questions about ICD-10 and Colorado Access, you can contact your provider representative. For more general information, visit cms.gov/ICD10.
What is a trading partner? A trading partner refers to any healthcare provider, payer, clearinghouse, or billing service.
What is the current status of your ICD-10 project? When will you begin testing externally? We are on track to be fully ready by the October 1, 2015 deadline. Our plan is to begin external testing with providers and trading partners beginning in 2nd Quarter 2015.
If a trading partner sends claim files with multiple payers, but one payer is not ICD-10 compliant by October 1, 2015, will you continue to accept ICD-9 codes for that payer until they have made the transition to ICD-10? Consistent with CMS guidelines, we will accept ICD-9 codes for dates of service prior to October 1, 2015. ICD-10 codes will be processed for dates of service effective October 1, 2015 and beyond.
Will this affect submission of paper claims? Along with the October 1, 2015 start date of ICD-10, we will no longer accept an outdated CMS1500 form because it will not accommodate the ICD-10 code format. The current, Form 1500 02/12 OMB Control Number 0938-1197, must be used to accommodate the ICD-10 format for claim submissions with dates of service October 1, 2015 and forward. You can locate a sample of the current CMS form(s) on the Centers for Medicare & Medicaid website. This is a sample only and cannot be printed or copied for use in submitting claims, you must purchase and submit original forms that are printed in red ink.
Can a claim contain both ICD-9 and ICD-10 codes? No. A claim cannot contain both ICD-9 and ICD-10 codes. This will require providers to split the claim so that all ICD-9 codes remain on one claim with dates of service (DOS) through September 30, 2015 and all ICD-10 codes placed on the other claim with DOS beginning October 1, 2015 and later.
Inpatient facility claims use the discharge date to determine whether ICD-9 or ICD-10 codes are submitted on a claim. If the patient is discharged prior to 10/1/15, ICD-9 codes should be submitted. If the patient is discharged on 10/1/15 or after, ICD-10 codes should be submitted.
Will you accept ICD-9 and ICD-10 claims in the same EDI/Electronic claim file? Yes. If the file includes ICD-9 codes for dates of service before October 1, 2015 and ICD-10 codes for dates of service on October 1, 2015, it will be allowed.
Is training available for ICD-10? Our own Dr. James Taylor, in partnership with the Colorado Medical Society, is presenting a "Physician's Perspective on ICD-10." For a current schedule of these ICD-10 trainings, and to register (space is limited), click here. A pre-recorded version of this training will be available online in September, at http://www.coaccess.com/provider-training. For questions about these trainings or to schedule an individual training for your provider group, please contact Dr. Taylor at