Since the ICD-10 compliance date on October 1, 2015, Independence has
noticed a number of common ICD coding
errors that are affecting claims processing. Below you will find types of claim
notifications and ICD-10 coding tips.
Claim notifications
Electronic claims submitters: If you submit claims
electronically, you receive a Health Care Claim Acknowledgment (277CA) for
notification of both accepted and rejected claims. It is important that this
notification is regularly reviewed.
The error description on the 277CA will aid you in correcting and resending
files to ensure an expedited remittance.
Providers should work with their clearinghouse/trading partner to ensure
accurate claims submission.
Paper claims submitters: Providers who continue to submit
paper claims will receive a claim return and cover sheet identifying the reason
for claims rejection(s). Providers should respond to that notification
accordingly and resubmit
the corrected claim for processing.
ICD-10 coding tips
Please follow the tips below to ensure that your claims are coded
correctly:
- Do not bill ICD-9 and ICD-10 codes on the same claim. Per
guidelines from the Centers for Medicare &
Medicaid Services (CMS), you cannot bill with both ICD-9 and ICD-10 codes on a
single claim unless otherwise
specified.
- Use the appropriate ICD code for inpatient and outpatient
claims. For dates of discharge (inpatient) or service
(outpatient) on or before September 30, 2015, you must bill with ICD-9 codes.
For dates of discharge (inpatient) or
service (outpatient) on or after October 1, 2015, you must bill with ICD-10
codes.
- Code DME and home infusion claims appropriately. Durable
medical equipment (DME) and home infusion
claims should be coded based on the ?From? date or initial date of service. If
the ?From? date is on or before
September 30, 2015, you must bill with ICD-9 codes. If the ?From? date is on or
after October 1, 2015, you must bill
with ICD-10 codes.
- Use the appropriate diagnosis qualifier:
- Paper claims. When billing with ICD-9 codes, you must use
the qualifier ?9?. When billing with ICD-10 codes,
you must use the qualifier ?0? (CMS-1500, box 21; UB-04, field 66).
- Electronic claims. Please refer to the most recent version
of the HIPAA-mandated 5010 ASC X12
Implementation Guides for the 837I and 837P transactions.
- Use valid codes. Whether you are billing with ICD-9 or
ICD-10 codes, please ensure that the codes you are using are valid and
appropriate.
For more information, visit our dedicated ICD-10 web page, which includes
Frequently Asked
Questions.
Benefits of submitting claims
electronically
We encourage all providers to submit claims electronically. Submitting
claims electronically can result in the
following:
- increased accuracy of claims
- better tracking ability
- greater efficiency and productivity within your office
In addition, you will also benefit from error reporting, which allows you to
easily correct claims before
submission. You will experience fewer payer rejections and administrative
concerns, resulting in faster claim
payments.
Refer to the Independence HIPAA Transaction
Standard Companion Guide for more information about submitting claims
electronically.