EM Coding Alert
Don't Count CMS Software a Pass
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.
Additionally, there are software programs, billing systems, and EMRs that house the ICD-9 and ICD-10 codes in such a way that they could be conceived as being a one-to-one match, but, beware of this type of coding. Rely on the provider’s documentation and your coding tools for the best code selection.
“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 .
Related Articles
EM Coding Alert
- ICD-10:
Check 5 Key Diagnosis Code Changes To Perfect Your ICD-10 Claims
Hint: Skip the V codes. Oct. 1, 2015 has come and gone, and you have [...] - ICD-10 Spotlight:
Primary Care: Pinpoint Infectious vs. Noninfectious Gastroenteritis
The tests ordered can help guide you in the right direction. When your provider documents [...] - ICD-10:
Revisit the ICD-10 Manual to Make Your Job Easier
Just because the book is thicker, doesn’t mean it is harder to use. Flipping through [...] - ICD-10:
Review the Changes to Your Most Common Diagnoses
Make sure your provider’s documentation will lead you to the right code. Hopefully your practice [...] - Reader Question:
Don't Count CMS Software a Pass
Question: I have heard that Medicare has created free billing software that will let us get [...] - Reader Question:
Avoid ICD-9 and ICD-10 on 1 CMS-1500 Form
Question: Our physician admitted a patient in September and didn’t discharge her until October. Because of [...] - Reader Question:
Not Enough Documentation? Turn to 'Unspecified'
Question: If I find that a common ICD-9 code that I use doesn’t have a direct [...] - You Be the Coder:
Coding 'Rule Out' Diagnoses
Question: My ED physician saw a patient for anterior wall chest pain. After he checked him [...]
