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Preparing for the ICD-10 transition

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.

Medicare Act prompts delay

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.

Icd 10 Final Rule

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 Subsequent 

  • ICD-10 diagnosis codes required on all production Claim Input Files and DDE add and update records.

Other requirements

  • 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. Obtain a copy of the final A copy of this final rule can be obtained here.

Contact the ClaimSearch team for more information. 


Mark Popolizio, J.D.

Mark Popolizio, J.D., is vice president of MSP compliance at ISO Claims Partners, a Verisk business. You can contact Mark at mpopolizio@verisk.com.


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