Outpatient Facility Coding Alert

CMS staff advise using partial code freeze to your advantage.

ICD-10 implementation is just over a year away, so it’s the perfect time to take a break from focusing on new diagnosis codes and zero in on the transition details your facility needs to know.

We’ve gathered some resources that can help you make sure you’re ready when ICD-10 goes into effect on Oct. 1, 2014.

Make a Clean Transition

You might think you’re ready to go with ICD-10, but you can’t get a jump start on the system.

“ICD-10 codes will not be recognized/accepted on claims before October 1, 2014,” says Sarah Shirey-Losso, Hospital Team Lead, Provider Billing Group of CMS in her April 18, 2013, National Provider Call presentation.

Nor can you use both code sets to help in your transition. “Claims cannot contain both ICD-9 codes and ICD-10 codes,” states Shirey-Losso in her presentation.

And don’t expect a grace period for ICD-10 implementation, experts say. ICD-9 codes will no longer be accepted beginning Oct. 1, 2014. On that date, all claims must use the new diagnosis code system.

Exception: For certain claims that span from pre-Oct. 1, 2014, through that date or beyond, you’ll need to split the claim. For instance, you should bill any outpatient hospital services that span the implementation date as two claims – you should list the first with the dates of service through Sept. 30, 2014 (using ICD-9 codes) and the second with dates of service Oct. 1, 2014 and later (using ICD-10 codes). However, for inpatient claims, you should use only the through date/discharge date and report ICD-10 codes, according to Shirey-Losso in her presentation.

Coder tip: “Diagnosis code set errors in institutional claims will return to provider (RTP), while errors in professional/supplier claims will return as unprocessable,” Shirey-Losso says.

Take Advantage of Partial Code Freeze

If you’re trying to make changes to prepare your practice for ICD-10 — like updating lists of common diagnosis codes for your high volume surgical procedures — the “partial code freeze” should make your job easier.

“The last regular, annual updates to both ICD-9-CM and ICD-10 code sets were made on October 1, 2011,” says Pat Brooks, RHIA, Senior Technical Advisor for the CMS Hospital and Ambulatory Policy Group.

Oct. 1, 2012 and Oct. 1, 2013 updates involve only limited code changes to both ICD-9 and ICD-10 “to capture new technologies and diseases,” according to Brooks. “On October 1, 2014, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses, [but] no updates to ICD-9, as it will no longer be used for reporting,” Brooks states in her presentation.

On October 1, 2015, regular updates to ICD-10 will begin.

Good news: That means that while you’re preparing for ICD-10 right now, and even during the first year of ICD-10 implementation, you can focus on the ICD-9 to ICD-10 transition. You won’t also have to deal with distractions based on numerous internal changes to the ICD-9 or ICD-10 code sets themselves.