The Centers for Medicare and Medicaid Services (CMS) released an alert in May 2014 announcing that the ICD-10 diagnosis codes reporting for Section 111 is postponed until October 1, 2015. A copy of the CMS alert can be obtained here.
The delay in transitioning from ICD-9 to ICD-10 codes is a result of the Protecting Access to Medicare Act of 2014 (Pub. L. No. 113-93), which precludes the Department of Health and Human Services (HHS) from using ICD-10 diagnosis codes before October 1, 2015.
As part of this alert, CMS has outlined the following timeline:
Before October 1, 2015
ICD-9 Diagnosis Codes
- RREs are to postpone reporting ICD-10 diagnosis codes on their production Claim Input Files and Direct Data Entry (DDE) submissions until October 1, 2015.
- RREs may submit ICD-9 diagnosis codes only on their production Claim Input Files and DDE submissions.
- The ICD Indicator field must contain a space or a “9” on Claim Input File Detail Records.
- The Diagnosis Code Indicator field must be set to ICD-9 for DDE submissions.
ICD-10 Diagnosis Codes
- ICD-10 diagnosis codes will NOT be accepted on production Claim Input File Detail Records or DDE submissions.
- ICD-10 diagnosis codes will be accepted on test Claim Input File Detail Records.
Starting October 1, 2015
CMS Date of Incident before 10/1/15
- ICD-9 or ICD-10 diagnosis codes will be accepted on all add and update records.
CMS Date of Incident 10/1/15 and Subsequen
- ICD-10 diagnosis codes required on all production Claim Input Files and DDE add and update records.
- When ICD-10 diagnosis codes are submitted on Claim Input Detail records, the ICD Indicator field must contain a zero.
- When ICD-10 diagnosis codes are submitted via DDE, the Diagnosis Code Indicator field must be set to ICD-10.
HHS recently released its final rule regarding ICD-10 transition and implementation. A copy of this final rule can be obtained here.
For more information
For questions or more information, please contact ClaimSearchMSP@iso.com.