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January 25, 2018

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Medical Coding News Archives

Alert! Paper Claims Must Have Code Set Indicator

October 21, 2015:

As of October 1, all Medicare paper claims must indicate which diagnosis code set—ICD-10-CM or ICD-9-CM—is being used to report the services provided. Failure to enter the indicator on the 1500 claim form will cause denials, payers warn.

So that payers know immediately how to process incoming claims, the revised CMS-1500 claim form is requiring providers to use an indicator of “9” in Item 21 to signal that the claim uses ICD- 9-CM codes and an indicator of “0” to signal use of ICD-10-CM.

The switchover to ICD-10-CM from ICD-9-CM October 1 means that, depending on when services were provided, claims could use either set of codes for a while. Claims for dates of service of September 30, 2015, or earlier must employ ICD-9-CM codes and those for services provided October 1 and later must use ICD-10-CM.

Remember that claims may not contain both ICD-9-CM and ICD-10-CM codes: separate claims must be submitted for services provided both before and after the October 1 implementation date. If a service has a “from” date of before October 1, the claim must use ICD-9-CM codes, even if the service ended after October 1.


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