ICD-10 Briefs

A resource for any health care provider who needs help with ICD-10: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf

Prior approvals are checked to see that the diagnosis and treatment meet guidelines, but the diagnosis codes on PAs generally aren't used to adjudicate claims, with a few exceptions in public health. That's why most PAs will not have to be split for ICD-10.

Dental and orthodontic claims generally do not require ICD-9 codes today; therefore, most will not be affected by the implementation of ICD-10 codes – with a few exceptions.

CPT codes aren't changing during the transition to ICD-10. Do you know the difference? One picture helps.

Have you taken a walk on the NCTracks ICD-10 Crosswalk? If not, take your first step here.

Have a question about ICD-10? Email us at NCTracks-Questioner@dhhs.nc.gov.

 

When dates of service span the October 1 deadline for ICD-10, you will need to split the claim in most cases, with the exception of hospital inpatient claims. A split claim is really two separate claims. You will submit an ICD-9 claim with dates of service before October 1 and an ICD-10 claim for dates of service on and after October 1.

ICD-9 codes and ICD-10 codes cannot be used on the same claim. However, claims with ICD-9 codes and claims with ICD-10 codes can be submitted in the same batch.

Some providers have asked if they could submit ICD-10 claims now. Claims with ICD-10 codes will be accepted by NCTracks beginning October 1, 2015, and no sooner, per federal mandate.

You can find the answers to many common ICD-10 questions on the ICD-10 Frequently Asked Questions (FAQ) page of the NCTracks Provider Portal.

The most common error identified in ICD-10 Provider/Trading Partner testing on NCTracks is a missing or incorrect ICD qualifier. An X12 List of ICD Qualifiers has been posted here.

The date of service determines whether you use ICD-9 or ICD-10 codes on the claim, regardless of when the claim is submitted. Submit an ICD-9 claim for dates of service before October 1 and an ICD-10 claim for dates of service on and after October 1. (Inpatient claims for hospital charges use date of discharge.)

Many have asked about ICD-10 training for NCTracks. The schedule has now been published and a recorded version of the training will be posted soon.

Everyday hundreds click on our ICD-10 Briefs. But a handful of you unsubscribe. Please don’t! This takes you off the list for all NCTracks updates. Re-subscribe here. The daily ICD-10 notices will end when ICD-10 begins.

How long will we continue to use ICD-9 codes after October 1? It depends on the disposition of your claims. Initial claims and any subsequent adjustments for services rendered before October 1 will use ICD-9 codes.

If you use a billing clearinghouse or trading partner to submit your claims to NCTracks and you have any difficulties with the transition to ICD-10 on October 1, you can always submit some (or all) of your claims through the NCTracks Provider Portal.

Does the July 6 CMS/AMA Joint Announcement regarding ICD-10 and Medicare also apply to Medicaid? The short answer is no. For a more detailed answer to that and other questions about the joint announcement, see the CMS Q&A.

Will NCTracks be Ready for ICD-10? Yes. We have completed system integration testing and user acceptance testing with NC DHHS, and are wrapping up testing with providers and trading partners representing a diversity of practices, specialties and facilities.

Not all diagnosis codes are expanding in the switch to ICD-10 codes. As of October 1st, the Outpatient Specialized Therapies policy will no longer require the use of a V-code to differentiate between services. The ICD-9 codes for physical therapy, occupational therapy and speech therapy collapse into one single ICD-10 code: Z51.89 Encounter for other specified aftercare. For more information, refer to the August 13 announcement.

When you call the NCTracks Contact Center, you will hear a message stating that qualifiers are required for ICD-10. This has confused some people who hear "modifier" instead of "qualifier." So to clarify, modifiers on CPT codes aren't changing as a result of ICD-10. By qualifier, we mean that each claim submitted after October 1 has to indicate whether it's using ICD-9 or ICD-10 codes. For more information, refer to the July 2 announcement and the ICD-10 training available in the secure NCTracks provider portal.

1. Mark your calendar for October 1. When you provide a service on or after October 1, you must use ICD-10 codes on the claim. Codes are NOT based on the date a claim is submitted.
2. Know your ICD-10 codes, and if you don't, check the Crosswalk.
3. Practice submitting an ICD-9 claim or two through the NCTracks portal now, even if you use a clearinghouse. This Plan B will allow you to maintain cash flow if you encounter problems.
 

CPT and HCPCS procedure codes will NOT change during the ICD-10 implementation. To distinguish an ICD from a CPT code, refer to this article: https://www.nctracks.nc.gov/content/public/providers/ICD10/ICD10-announcements/How-to-Recognize-an-ICD-Code.html

Whether it's a misunderstanding or a rumor, it's wrong. Contrary to what some providers have understood, the federally mandated October 1 deadline stands. There is no delay or grace period for Medicaid. Claims submitted by all providers to NCTracks with date of service or date of discharge on or after October 1 must have ICD-10 codes. No exceptions.

Providers can use the NCTracks ICD-10 Crosswalk and the DHB policies to determine the correct ICD-10 code. Neither the agents in the NCTracks Contact Center nor any DHHS employee can determine what the right diagnosis code is for any particular situation. Determining the correct diagnosis code can only be done by the medical professional treating the patient.