General Surgery Coding Alert

Question: The surgeon admitted a patient at the end of September and completed the patient discharge in October. Because of the ICD-10 implementation, we are not sure how to bill this claim. Do we use both ICD-9 and ICD-10 codes on the same claim since the dates of service span the implementation date?

California Subscriber

Answer: No, you should not use both code sets on a single claim. Instead, you will need to submit two claims — one using ICD-9 codes and one using ICD-10 codes.

Here’s why: CMS will return claims as unprocessable if they contain both ICD-9 and ICD-10 diagnostic codes, and you won’t get paid.

“A claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will return to provider all claims that are billed with both ICD-9 and ICD-10 diagnosis codes on the same claim. For dates of service prior to October 1, 2015, submit claims with the appropriate ICD-9 diagnosis code. For dates of service on or after October 1, 2015, submit with the appropriate ICD-10 diagnosis code,” according to MLN Matters article SE1408.

Exception: Anesthesia claims that begin on Sept. 30, 2015, and end on Oct. 1, 2015 will be billed using Sept. 30 as both the “from” and “through” date, and should be billed using ICD-9 codes.

Read more: You can read the full CMS article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1408.pdf.