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:
Providers may contact their Medicare Administrative Contractor at their toll-free number, which is available at:
The MLN Matters article (SE1408) is available at:
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.