Gastroenterology Coding Alert

Participate in the upcoming testing drives in March and June to check your preparedness.

CMS has pushed back the date for ICD-10 implementation several times, which means many providers are already prepared for the transition. However, every facility and physician office should continue to stay on top of ICD-10 changes and updates as the Oct. 1, 2015, date gets closer. One way to do this is by participating in CMS’s ICD-10 testing opportunities to ensure that they are compliant and prepared.

All of the Part B MAC claims processing systems are currently ready for ICD-10, CMS stated in a 2014 MLN Matters article SE1409. In addition, CMS tests its ICD-10 software every time a quarterly release is issued. On the provider side, CMS is offering three separate testing weeks for ICD-10 acknowledgement. The first took place in November 2014. Other dates will be in March and June 2015. If you’d like to participate in the testing, visit your MAC’s website. CMS will also offer end-to-end testing opportunities to select practices, but have not yet announced the dates or how to volunteer. 

CMS Offers Alternative for the Unprepared

On the off-chance that your practice’s software isn’t ready to convert to ICD-10 next October, CMS has a potential solution for you.

“If you will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015, you should investigate downloading the free billing software that CMS offers via their MAC websites,” CMS says in the MLN Matters article. “The software has been updated to support ICD-10 codes and requires an internet connection. This billing software only works for submitting Fee-for-Service (FFS) claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance,” CMS adds.

Resource: To read MLN Matters article SE1409, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1409.pdf.

Testing update: The Centers for Medicare & Medicaid Services (CMS) processed 14,929 test claims during a Jan. 26 to Feb. 3 testing period, from 661 participating providers. An overwhelming majority of claims — 81 percent — were accepted through the system, and the remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:

• Invalid submission of ICD-9 codes (seen in three percent of rejected claims)
• Invalid submission of ICD-10 codes (as demonstrated by another three percent of claims that didn’t pass through the system)
• Errors unrelated to ICD-10, such as using an incorrect NPI, an invalid date, the wrong place of service or an incorrect HCPCS code (seen in 13 percent of rejected claims)

Wait Until Oct. 1 to Use ICD-10

The date of service errors led CMS to discover that some providers are confused about when they can submit claims with ICD-10 codes in both the testing arena and the real, “non-testing” world, said CMS Administrator Marilyn Tavenner in a Feb. 25 blog post on the topic.

“ICD-10 can be used only for test purposes before October 1,” said Tavenner, who will be leaving her CMS post at the end of this month. “Only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.”

Overall, the testing results indicate that the majority of health care providers are poised to succeed under the ICD-10 system — and those who aren’t should step up their training to be ready in time for the Oct. 1 deadline.

To read Tavenner’s statistics on the end-to-end testing, visit blog.cms.gov/2015/02/25/successful-icd-10-testing-shows-industry-ready-to-take-next-step-to-modernize-health-care.