ICD-10 Decisions - Tell us what you think

ICD-10 Issues for your consideration

International Classification of Diseases, Tenth Revision (ICD-10) issues under consideration will be published here, and you are invited to provide input and ask questions to help us make decisions. Tell us what you think via the ICD-10 emailbox at INXIX.ICD10Questions@HP.com. Please include your contact information in your email, so the ICD-10 team can contact you if more information is needed.

ICD-10 Decisions

The following ICD-10 issues have been reviewed and decided. They are posted here until they appear in an Indiana Health Coverage Programs (IHCP) bulletin, when we will add a link from this web page to the bulletin. Eventually, these decisions will become part of the IHCP Provider Manual. If you have comments or questions, please send them to the ICD-10 team at INXIX.ICD10Questions@HP.com.

Forms

The Prior Authorization Request form and the Notification of Pregnancy (NOP) form will be updated to include ICD-10 information. More information will be provided in future publications, as it is available.

ICD-10 Span Date Logic

The following tables outline the CMS recommendations for submitting and processing claims with dates of service that span the ICD-10 implementation date of October 1, 2013, and an explanation of how the IHCP will process these claims. The IHCP intends to follow Medicare as much as possible, and seek clarification from the CMS regarding which CD-10 codes to use and the claim format for reporting.

Institutional provider claims

Facility type/service Claims processing requirement Effective October 1, 2013

Inpatient hospital
(hospital, prospective-payment system hospital, long-term care hospital, critical access hospital)

HP:
Claim Type I (inpatient) and A (inpatient crossover)

Medicare:
If the hospital claim has a discharge and/or THROUGH date on or after October 1, 2013, then the entire claim is billed using ICD-10.

IHCP:

  • The IHCP now requires the use of Occurrence Code 51 to indicate discharge. Occurrence Code 51 will continue to be required for this purpose, but will not be used to validate the ICD-10 code.
  • The IHCP now uses the FROM date of service for inpatient (I) and (A) claim types; however, with ICD-10 implementation, this will change to use of the THROUGH date.
  • Providers are not allowed to mix ICD-9 and ICD-10 codes on the same claim.
 Use THROUGH date.

Outpatient

HP:
Claim Type C (outpatient crossover) and O (outpatient)

Federally Qualified Health Clinic (FQHC) (effective April 4, 2010)

Medicare:
Split claims - Requires providers to split claims so all ICD-9 codes remain on one claim and all ICD-10 codes remain on the other claim.

IHCP:

  • For dates of service that span the compliance date of October 1, 2013, providers must separate claims submission so that ICD-9 codes remain on one claim (dates of service before October 1, 2013) and all ICD-10 codes remain on the other claim (dates of service on or after October 1, 2013).
  • Providers now use the FROM date; continue to use the FROM date.
  • FQHC crossover claims from Medicare are processed as outpatient crossover claims. However, when an FQHC claim is for a member with no Medicare, the claim is submitted on a CMS-1500 claim form.
 Use FROM date.
Skilled nursing

HP:
Claim Type L (long-term care) and A (inpatient crossover)

Medicare:

If the long-term care (LTC) claim has a discharge and/or THROUGH date on or after 10/1/2013, the entire claim is billed using ICD-10.

IHCP:

Follow the Medicare requirement.

 Use THROUGH date.
Home health

HP:
Claim Type H (home health)		 Medicare:

Split claims - Requires providers to split the claim so all ICD-9 codes remain on one claim and all ICD-10 codes remain on the other claim.

IHCP:
For dates of service that span the compliance date of October 1, 2013, providers must separate claim submissions so ICD-9 codes remain on one claim (dates of service before October 1, 2013) and ICD-10 codes remain on the other claim (dates of service on or after October 1, 2013).

 Use FROM date.

Professional claims

Facility type/service Claims processing requirement Effective October  1, 2013
All anesthesia claims
All specialties billed on professional claims

HP:
Claim Type M (medical) and B (medical crossover)		 Medicare:

Anesthesia procedures that begin on September 30, 2013, but end on October 1, 2013, are to be billed with ICD-9 diagnosis codes and use September 30, 2013, as both the FROM and THROUGH dates.

IHCP:

Follow the Medicare recommendation; use the FROM date.

 Use FROM date.

Supplier claims

Facility type/service Claims processing requirement Effective October  1, 2013
DME
Claim Type M (medical) and B (medical crossover)

Medicare:

Billing for certain items or supplies (such as capped rentals or monthly supplies) may span the ICD-10 compliance date of October 1, 2013 (as when the FROM date of service occurs before October 1, 2013, and the THROUGH date of service occurs on or after October 1, 2013). In this case, use the FROM date as both the FROM and THROUGH dates.

IHCP:

Follow the Medicare recommendation; use this logic for all span dates.

 Use FROM date.