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The Centers for Medicare & Medicaid Services (CMS) issued an updated version of the Medicare fee-for-service claims processing guidance for implementation of the International Classification of Diseases, 10th Edition (ICD-10) to reflect the October 1, 2014 implementation date.  Providers must submit claims with the appropriate ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2014.  CMS provides the following guidance for submitting claims on or after October 1, 2014:

  • Providers and suppliers will continue to be required to report all characters of a valid ICD-10 code on claims. 
  • Providers and suppliers must submit the most specific diagnosis codes based upon the information that is available.
  • Medicare will return institutional claims, as well as professional and supplier claims containing ICD-9 codes for dates of service on or after October 1, 2014, and providers must re-submit the claim with the appropriate ICD-10 code.  
  • Medicare will return claims that are billed with both ICD-9 and ICD-10 procedure codes on the same claim.

CMS has noted potential claims processing issues for institutional, professional, and supplier claims that span the implementation date.  CMS provides a table in the Medicare Learning Network (MLN) Matters article SE1408 that provides guidance to providers for claims that span the periods before and after the ICD-10 implementation date.

Further information on the format of ICD-10 codes is available at:

http://www.cms.gov/Medicare/Coding/ICD10/index.html.  

Providers may contact their Medicare Administrative Contractor at their toll-free number, which is available at:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/provider-compliance-interactive-map/index.html.

The MLN Matters article (SE1408) is available at:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1408.pdf.

Centers for Medicare & Medicaid Services.  “Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Disease, 10th Edition (ICD-10) – A Re-Issue of MM7492.”  MLN Matters Number SE1408.  05 Feb. 2014. 

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