Effective October 1, 2015, CMS implemented ICD-10-CM (diagnoses) and ICD-10-PCS (inpatient procedures), replacing the ICD-9-CM diagnosis and procedure code sets. As a provider, vendor, biller, or administrator, you will need to submit claims appropriately in order to avoid denials.
To learn more, select a question below.
All claims submitted with dates of service (DOS) after October 1, 2015 must use ICD-10 codes. Combinations of ICD code versions must not be submitted together on a claim. Providers are expected to use the appropriate ICD qualifier (Diagnosis Type Code within the ASC X12 v5010 standard), which Healthfirst uses to distinguish between ICD-9 and ICD-10 code submissions. This means that if the qualifier indicates ICD-9, then the code must be a valid ICD-9 code; if the qualifier indicates ICD-10, then the code must be a valid ICD-10 code. Mixing the qualifiers and diagnosis codes will result in your claim being denied.
These guidelines are very important, as any claims submitted without the appropriate code versions will be denied.
For X12 837P 5010A1 claims, the HI01-1 field for the Code List Qualifier Code must contain the code “ABK” to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code “ABF” for the Code List Qualifier Code to indicate up to 11 additional ICD-10 diagnosis codes that are sent.
For X12 837I 5010A1 claims, the HI01-1 field for the Principal Diagnosis Code List Qualifier Code must contain the code “ABK” to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code “ABF” for each Other Diagnosis Code to indicate up to 24 additional ICD-10 diagnosis codes that are sent.
For NCPDP D.0 claims, in the 492.WE field for the Diagnosis Code Qualifier, use the code “02” to indicate an ICD-10 diagnosis code is being sent.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was released in May 2013 and took effect on January 1, 2014. As was the case with DSM-IV, the codes within DSM-V contain valid ICD-9 Clinical Modification (CM) codes that can be used to bill dates of service prior to September 30, 2015.
Effective October 1, 2015, the ICD-10-CM codes are the official system that must be used. ICD-10-CM codes are already included in the DSM-V and are listed in parentheses next to each disorder title. Simply use the codes listed in parentheses to code your diagnoses on health insurance claims for services rendered on and after the implementation date of October 1, 2015.
Code Correctly – All claims submitted with dates of service (DOS) after October 1, 2015 must only include ICD-10 codes.
Don’t Combine Code Versions – Combinations of ICD code versions (ICD-9 and ICD-10) must not be submitted together on a claim.
Use the correct ICD-10 Qualifier Code – Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers. More information on qualifier codes for ICD-10 can be found here.
ICD-10 Code Converter Tool
This tool is based on the General Equivalency Mapping (GEM) files published by CMS, and is not intended to be used as an ICD-10 conversion, ICD-10 mapping, or ICD-9 to ICD-10 crosswalk tool. Keep in mind that while many codes in ICD-9-CM map directly to codes in ICD-10, in some cases, a clinical analysis may be required to determine which code or codes should be selected for your mapping. Always review mapping results before applying them.
|Other ICD-10 Resources|
|CMS ICD-10 Resources|
|The ICD-10 Transition: An Introduction|
|Institutional Services Split Claims Billing Instructions for Medicare Fee-For-Service (FFS) Claims|
|ICD-10 Resources for Providers|
|ICD-10 Resources for Vendors|
|The ICD-10 Transition: Focus on Non-Covered Entities|
|Road to 10: The Small Physician Practice’s Route to ICD-10|