Ophthalmology and Optometry Coding Alert

Question: Our practice is considering submitting claims with ICD-10 codes before the implementation date in October 2014 to ensure we are using the proper codes. Can we do this?

Tennessee Subscriber

Answer: As most practices are aware, the ICD-10 diagnosis coding system will take effect on Oct. 1, 2014, and you’ll have to be ready to make the transition swiftly. CMS will not allow a grace period after that date, nor will they accept both ICD-9 and ICD-10 codes on your claims. But you should not try using the ICD-10 codes before the implementation date.

To try and assist with the transition that you’ll face next year, CMS revised MLN Matters article MM7492 last week to remind practices of the vast changes that will take place next year. The following tips from the article will help you prepare:

Claims with both ICD-9 and ICD-10 claims submitted for dates of service on or 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) starting Oct. 1, 2014.

Certain services that span from pre-Oct 1, 2014 through after that date will have to be split into separate claims. For instance, any outpatient hospital services that span the implementation date will be billed as two claims – the first will be listed with the dates of service through Sept. 30, 2014 (using ICD-9 codes) and the second will be listed with dates of service Oct. 1, 2014 and later (using ICD-10 codes).

However, anesthesia claims that begin on Sept. 30, 2014, and end on Oct. 1, 2014 will be billed using Sept. 30 as both the “from” and “through” date, and should be billed using ICD-9 codes, the article says.

Don’t try and get a jump start on billing with ICD-10 codes, since CMS will reject any ICD-10 submission for dates of service prior to Oct. 1, 2014.

Keep in mind: The ICD-10 implementation date in the MLN Matters article was not updated and appears incorrectly as October 1, 2013, but the true implementation date is still Oct. 1, 2014, explains MAC CGS on its website. Watch for a corrected version of the article to appear soon.

To read the complete article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7492.pdf.