Orthopedic Coding Alert

Question: I have heard that Medicare has created free billing software that will let us get around the ICD-10 conversion. I was told the software will automatically convert our ICD-9 coding to ICD-10. Is this correct?

Iowa Subscriber

Answer: Not quite. If your claim submission software is preventing you from submitting ICD-10 codes on your claims, CMS is offering free billing programs that will allow you to electronically submit your claims using the new diagnoses. But contrary to what many practices believe, this software is not an ICD-10 workaround — you still have to make the conversion from ICD-9 codes.

“You may download the free billing software that CMS A/B MACs offer on their web pages,” CMS says in MLN Matters article SE1522. “Please note that submitting electronic claims to Medicare using the free billing software does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional claims) or dates of service DISCHARGE/THROUGH dates (on institutional claims) on or after Oct. 1, 2015,” the article says. CMS stresses that any claims with ICD-9 codes submitted for dates of service on or after Oct. 1 will be rejected.

If the free software won’t do the trick for your claims submissions, and you meet one of the exceptions, you can submit using paper claims with ICD-10 codes, but check the CMS website first to ensure that you qualify for a waiver. The exceptions guidelines can be found at www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/ASCAWaiver.html.

Resource: To read MLN Matters SE 1522 with information on how to submit ICD-10 claims if your system isn’t able to handle them, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/SE1522.pdf.