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Understanding ICD-10 Changes for Providers: Key Information and Submission Guidelines

The transition to ICD-10 expands diagnosis and surgical procedure code sets, increasing specificity and compliance with HIPAA mandates. Effective October 1, 2014, all bills for services on or after this date must use ICD-10 codes; those for dates prior must continue using ICD-9. Mixed billing with ICD-9 and ICD-10 on the same bill is prohibited. Additionally, the updated 1500 Claim Form version 02/12 is required for submitting claims after this transition. For comprehensive resources, visit the CMS ICD-10 website.

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Understanding ICD-10 Changes for Providers: Key Information and Submission Guidelines

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  1. ICD-10 Providers Information

  2. What changes with ICD-10? • Expanded diagnosis and surgical procedure code sets to be much more specific • Expanded field format for ICD-10 codes • From 3-5 to 3-7 • Compliance of HIPAA mandate to have bills paid effective 10/1/14 • Bills with dates of service on or after 10/1/14 must use ICD-10 codes to be paid • Bills with dates of service prior to 10/1/14 must continue to use ICD-9 codes to have bills paid • IP Bills with a discharge date on or after 10/1/14 must use ICD-10 codes to be paid • IP Bills with a discharge date prior to 10/1/14 must continue to use ICD-9 codes to be paid • Bills cannot contain both ICD-9 and ICD-10 codes on the same bill

  3. ICD-10 AnnouncementsProvider The Office of Workers’ Compensation Programs (OWCP) will adopt the use of the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) on a schedule aligned with the Centers for Medicare & Medicaid Services (CMS) For services provided on or after October 1, 2014, OWCP will require all providers to only use the ICD-10 code sets For services provided prior to October 1, 2014, only ICD-9 codes will be accepted We will be following CMS guidance for implementing ICD-10 on October 1, 2014.  Please visit the CMS ICD-10 website for additional information, resources and the latest news on the ICD- 10 transition, http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10

  4. Web Homepage http://owcp.dol.acs-inc.com/portal/main.do

  5. 1500 Claim Form Changes The National Uniform Claim Committee (NUCC) has approved a transition timeline for the version 02/12 1500 Health Insurance Claim Form (1500 Claim Form).  In June, the NUCC announced the approval of the updated 1500 Claim Form that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type Effective March 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12) ICD-10 codes will be rejected as an invalid code until October 1, 2014

  6. How to Submit a 1500 • Instructions on completing the new 1500 can be found at the following website under forms and links • http://owcp.dol.acs-inc.com/portal/main.do

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