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Are You Ready to Transition to ICD-10 Codes


Posted on August 18, 2015 by J Seabrook

The U.S. Department of Health and Human Services (HHS) issued its final ruling on ICD10 implementation with a deadline of October 1, 2015. Thereafter Medicare claims with a date of service on or after October 1st will not be accepted without a valid ICD-10 code.  For 12 months following October 1st 2015, claims will not be denied but will be required to have a valid 1CD-10 code otherwise billing will be unsuccessful.

Molecular Pathology Laboratory Network (MPLN) will switch with full implementation to the new ICD-10 codes on October 1st. For all Medicare and 3rd party insurance patient bill we will require you to provide the correct ICD-10 code beginning October 1st. Prior to October 1st we will accept only ICD-9 codes. On and after October 1st we will only accept ICD-10 Codes per CMS as of July 31st 2015.

For more information please review the CMS website and / or call MPLN customer service for help with providing the correct ICD-10 codes on the patient requisition form.

This change will impact any HIPAA covered entity and you may also experience reimbursement changes. Below are links to CMS information on ICD-10

The Change from ICD-9 to ICD-10 is significant and you should already have been notified by CMS and begun your implementation. To simplify this process we will be providing a ICD-9 to ICD-10 crossover matrix for the top ICD codes used at MPLN. A copy of this crossover sheet is attached here.

Basics of the ICD-10 code. There are now up to 7 alphanumeric characters.

The first 3 characters are related to the condition (disease, injury or body area), the 4th character further describes the condition by site, etiology, manifestation or stage. The 5th and 6th characters add the most accurate level of specificity defined by location or laterality. The 7th character is used for the episode of care. Where the 7th character is used and any of the 4th-6th are not used a placeholder is required "X" for the absent 4th-6th character(s).

You can find more information on the CMS website by clicking below:

CMS letter to Medicare providers https://www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf


ICD-10 Physician practice guidance http://www.roadto10.org/


CMS complete guidance https://www.cms.gov/ICD10

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