Inpatient Facility Coding & Compliance Alert

Question: We have few patients who were admitted for procedures at the end of September and these patients were discharged in October 2015. Do we restrict to only ICD-10 codes or 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.

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. 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.

You can instead try submitting two claims — one using ICD-9 codes and one using ICD-10 codes. This will depend upon the date of service.

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