IHCP reminds transportation providers about ICD-9 vs ICD-10 requirements

Dates of service before October 1, 2015

To submit claims that have dates of service (DOS) before October 1, 2015, via Web interChange, transportation providers must use an applicable ICD-9 diagnosis code (see Table 1) AND change the ICD indicator on Web interChange from ICD-10 to ICD-9.

To submit paper claims with DOS before October 1, 2015, transportation providers must use an applicable ICD-9 code (see Table 1) in field 21A of the claim form AND must use "9" in the "ICD Ind." box in field 21 of the claim form to denote that an ICD-9 code was used.

Table 1 - ICD-9 Codes Frequently Used by Transportation Providers

ICD-9 Diagnosis Code Usage Instructions
V56.0, V56.1, or V56.8 Use for patients undergoing renal dialysis
V70.5 Use for patients residing in nursing facilities
7999 Use when an actual diagnosis is not known for patients not undergoing dialysis or who do not reside in a nursing facility

Dates of service on or after October 1, 2015

To submit claims with DOS on or after October 1, 2015, via Web interChange, transportation providers must use an applicable ICD-10 diagnosis code (see Table 2). The ICD indicator automatically defaults to ICD-10.

To submit paper claims with DOS on or after October 1, 2015, transportation providers must use an applicable ICD-10 code (see Table 2) in field 21A of the claim form AND must use "0" in the "ICD Ind." box in field 21 of the claim form to denote that an ICD-10 code was used.

Table 2 - ICD-10 Codes Frequently Used by Transportation Providers

ICD-10 Code Usage Instructions
Z49.01, Z49.31, Z49.32 Use for patients undergoing dialysis
Z02.89 Use for patients residing in nursing facilities
R69 Use when an actual diagnosis is not known for patients not undergoing dialysis or who do not reside in a nursing facility