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ICD-10
Are you ready for 10/1/15 ?
What is ICD-10 CM and ICD-10 PCS
ICD-10 is the International Classification of Diseases, 10th Revision. The Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) modified ICD-10 for use in the U.S. by classifying the codes into two categories: ICD-10 CM and ICD-10 PCS.
ICD-10 CM
The U.S. Clinical Modification (CM) of
WHO ICD-10 will be used by both
Providers and Inpatient Hospitals.
ICD-10 PCS
The U.S. Procedure Coding System
(PCS) will be used for Inpatient
Hospital procedures.
CPT
CPT codes cover the following Outpatient settings:
- Hospital Outpatient - Behavioral Health
- All Other Facilities
ICD-10: Compliance Update
In July 2014, the U.S. Department of Health and Human Services (HHS) issued a final rule confirming October 1, 2015 as the new ICD-10 compliance date. The rule also requires the continued use of ICD-9 through September 30, 2015.
Horizon BCBSNJ will not accept ICD-10 claims prior to October 1, 2015.
For legislative updates on ICD-10 compliance, visit:
Department of Health and Human Services at www.hhs.govThe Centers for Medicare & Medicaid Services at www.cms.gov/icd10
The Workgroup for Electronic Data Interchange at www.wedi.org/workgroups/icd-10
ICD-10: Business Partner Testing
We have successfully completed ICD-10 testing with the clearing houses and vendors listed below.
If you work with a clearinghouse or vendor not listed above, please speak with them about ICD-10 readiness and testing.
Clearing Houses Vendors
EmdeonGaffeyMedAssetsRelay HealthZirmedOffice Ally
Affiliated Professional Services, Inc. Apex EDIAthena Health Care SystemsC&S Research CorporationCerner Corporation (formerlySiemens Health Services)Claim LogicClear Benefits, Inc. Coordination of Benefits Agreement(COBA) MedicareeProvider Solutions GE Commerce (GE Centricity) GHN Online, Inc.
Group Health Inc. (GHI) Medicare Crossover CarrierHealthFusion, Inc.Health Management System (HMS)I.E. Schaffer & Co.MD On-LinePassport HealthPractice InsightPrime TherapeuticsSTI Computer Services, Inc.Subsidium HealthcareValueOptionsWebMD®
ICD-10: Electronic and Paper Claims
If you submit electronic claims through NaviNet, please note that this online tool is ready to support ICD-10 and will accept ICD-10 codes for dates of services on or after 10/1/15 or as mandated by CMS.
Practitioners • If you submit paper claims to Horizon BCBSNJ, please note that in 2014, CMS released the new
CMS 1500 Claim Form (Version 02/12) that was revised to accommodate ICD-10 codes.
• Horizon BCBSNJ began accepting Version 02/12 in January 2014 and will continue to accept Version 02/12 and the previous CMS 1500 Claim Form (Version 08/05) until the ICD-10 compliance date.
• Paper claims with ICD-10 codes will be accepted by Horizon BCBSNJ on or after 10/1/15 or as mandated by CMS.
FacilitiesIf you submit paper claims to Horizon BCBSNJ, please use the UB04 form. Paper claims with ICD-10 codes will be accepted by Horizon BCBSNJ on or after 10/1/15 or as mandated by CMS.
• The UB04 form will remain the same and has not changed for ICD-10.
Provider Coding for ICD-10
Don’t Forget the Importance of Clinical Documentation in ICD-9 and ICD-10
Make patients’ medical records more meaningful.
Improve productivity by reducing coder queries.
Reduce claim pends because claims are more accurately coded.
Support quality indicators.
Lay the foundation for a smoother transition to ICD-10.
ICD-10: Tools and Resources
Take advantage of resources offered by the Centers for Medicare & Medicaid Services (CMS):
Road to 10 tool is designed to help small practices start their transition to ICD-10. Road to ICD-10 can be found at roadto10.org
Horizon Behavioral Health is using CMS GEMS as the basis for mapping ICD-9 to ICD-10. Mappings have been modified in some cases to maintain the clinical intent of our medical policies. Additional information can be located on the CMS website: https://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html
CMS ICD-10 Code LookupCoding Conversion Tool
Contact Information
Questions ?
Visit our website at www.horizonblue.com/providers
Click on Resources, Initiatives and then select the ICD-10 link.
If you have any questions or require more information,
send an email to [email protected]
or
call Provider Relations at
1-800-397-1630 (8 am - 8 pm ET Monday – Friday)
