Home Health ICD-9/ICD-10 Alert

Published on Wed Jun 12, 2013 PDF

Question: How will we handle diagnosis codes on claims that span the Oct. 1, 2014 implementation date? I know that we’ll need to report ICD-10 codes for new patients starting on or after the implementation date, but how will we code for existing patients?

Massachusetts Subscriber

Answer: The Centers for Medicare & Medicaid Services has spelled this part of the transition process out for you in a newly revised MLN Matters article.

Claims with both ICD-9 and ICD-10 claims submitted for dates of service on after Oct. 1, 2014 will be returned as unprocessable and you’ll receive no reimbursement for them. Therefore, report only the ICD-10 code(s) after Oct. 1, 2014, says MLN Matters article MM7492.

MACs will use the “through” date on final home health claims to determine whether an ICD-9 or ICD-10 code is required, CMS says. But agencies may find coding instructions rather confusing for claims that straddle Oct. 1. For home health final claims, CMS tells its contractors to “allow HHAs to use the payment group code derived from ICD-9 codes on claims which span 10/1/2014, but require those claims to be submitted using ICD-10 codes.”

Requests for anticipated payment (RAPs) “can report either an ICD-9 code or an ICD-10 code based on the one (1) date reported,” the article says. “Since these dates will be equal to each other, there is no requirement needed. The corresponding final claim, however, will need to use an ICD-10 code if the HH episode spans beyond 10/1/2014.”

Home health outpatient claims for Part B services like therapy will split claims based on date of service, with ICD-9 codes on claims with dates of service through Sept. 30 and ICD-10 codes for claims Oct. 1 and later.

Hospice will also use split claims with ICD-9 codes used prior to 10/1/2014 and ICD-10 codes for 10/1/2014 and later.

Also: Be ready to make the transition swiftly when it’s time to switch to ICD-10. CMS will not allow a grace period after Oct. 1.

The article is online at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7492.pdf Please note that the dates in the article use 2013 as the ICD-10 transition date but a link within the article modifies the date to 10/1/2014.