ICD-10 Implementation Billing Guide
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1 ICD-10 BILLING INSTRUCTIONS: SERVICES Split Claims s who submit claims for the following services are required to split the claim so that claims for dates of service through September 30, 2015, contain ICD-9-CM diagnosis codes. Claims with dates of service on or after October 1, 2015, contain ICD-10-CM diagnosis codes: Allied Health Acupuncture (ACU) Audiology and Hearing Aids (AUD) Chiropractic (CHR) Durable Medical Equipment and Medical Supplies (DME) Medical Transportation (MTR) Orthotics and Prosthetics (OAP) Psychological Services (PSY) Therapies (THP) Outpatient Services AIDS Waiver Program (AID) Clinics and Hospitals (CAH) Chronic Dialysis Clinics (DIA) Community Based Adult Services (formerly Adult Day Health Care Centers) Expanded Access to Primary Care Program (EAP) Heroin Detoxification (HER) Home Health Agencies/Home and Community-Based Services (HOM) Hospice Care Program (HOS) Local Educational Agency (LEA) Multipurpose Senior Services Program (MSS) Rehabilitation Clinics (REH) Long Term Care Long Term Care (LTC) Medical Services General Medicine (GM) Obstetrics (OB) Pharmacy Pharmacy (PH)
2 Vision Care Vision Care (VC) Specialty Programs Child Health and Disability Prevention (CHDP) program Family Planning, Access, Care and Treatment (Family PACT) Through Date Inpatient Services (IP) s who submit claims for Inpatient Services or Inpatient Hospital Claims with a discharge date and/or through date on or after October 1, 2015, should be sure the claim contains ICD-10-CM/PCS codes. Claims with a discharge date and /or through date on or before September 30, 2015, should contain ICD-9-CM/Volume 3 codes. Note: Claims for stays involving interim claims that overlap the ICD-10 implementation date of October 1, 2015, should be billed using ICD-10-CM/PCS codes. The final claim for stay or subsequent interim claims should be billed using ICD-10-CM/PCS codes. Prior to the ICD-10 implementation date, the long stay involving interim claims should be billed using ICD-9-CM/Volume 3 codes. Example: s submitting multiple claims that overlap the ICD- 10 implementation date: 1. A provider submitted an interim claim with dates of service 8/15/15 9/15/15 using ICD-9-CM diagnosis codes. 2. The provider submitted a second interim claim with dates of service 9/16/15 10/16/15 using ICD-10-CM diagnosis codes. 3. The provider submits a final claim with dates of service 8/15/15 10/30/15 using ICD-10-CM diagnosis codes and the interim claims will be voided.
3 Special s Anesthesia Claims (Split Claims) s who submit Anesthesia claims when a billed time frame overlaps the October 1, 2015, implementation date must submit two claims. One claim for the time units prior to October 1, 2015, must contain ICD-9-CM diagnosis codes and one claim for the time units on or after October 1, 2015, must contain ICD-10-CM diagnosis codes. Block Billing/From-through Billing (Split Claims) types (HOM, HOS, LEA, etc.) that are allowed to do Block Billing, often referred to as From-Through Billing, must submit two claims: one claim with from-through billing for dates of service prior to October 1, 2015, containing ICD-9-CM diagnosis codes and one claim with from-through billing for dates of service on or after October 1, 2015, containing ICD-10-CM diagnosis codes. Out-of-State Emergency Services Out-of-State providers who have provided emergency services spanning the October 1, 2015, implementation date for ICD-10 should refer to the detailed ICD-10 billing instructions below to determine if their provider type should split bill or use a through date for billing proposes. s Type Type Code Type Description 01 Adult Day Health Care Centers 02 Assistive Device & Sick Room Supply Dealers 03 Audiologists 03 Audiologists Group 04 Blood Banks 05 Certified Nurse Midwife 05 Certified Nurse Midwife Group 07 Certified Nurse Practitioner (1201 App) 07 Certified Nurse Practitioner Family 07 Certified Nurse Practitioner Family Pediatric 08 Christian Science Practitioner 09 Clinical Laboratories 10 Group Certified Nurse Practitioner (1201 App) 10 Group Certified Nurse Practitioner Family 10 Group Certified Nurse Practitioner Pediatric 11 Fabricating Optical Laboratory/PIA 12 Dispensing Opticians
4 Type Code Type Description 13 Hearing Aid Dispensers 14 Home Health Agencies 15 Community Hospital Outpatient Dept. 16 Community Hospital Inpatient (Non-Contract) Through Date 16 Community Hospital Inpatient (Contract) Through Date 16 Community Hospital Inpatient (Non-Contract) Through Date 16 Community Hospital Inpatient (Out of State) Through Date 16 Community Hospital Inpatient (Non-Contract) Through Date 16 Community Hospital Inpatient (Out of State) Through Date 16 Special "Shell" Number for "Disproportionate Share" Through Date 16 Transitional Inpatient Care/General Acute Care Through Date 17 Long Term Care Facility 17 Rural Hospital Distinct Parts Through Date 17 Sub-Acute (Adult) Long Term Care Facilities 17 Long Term Care Facilities Only Title 19 (Effective after OBRA 10-90) 17 Transitional Care/LTC 18 Nurse Anesthetists 18 Group Nurse Anesthetists 19 Occupational Therapists 19 Occupational Therapists Group 20 Optometrists 21 Orthotists 21 Orthotists Group 22 Physicians Group 23 Optometric Group 24 Pharmacies/Pharmacist 25 Physical Therapists 25 Physical Therapy Group 26 Physicians 26 Physician (Osteopaths DO) 26 Physician (Out of Country) 26 Physician's Certificate of Registration 27 Podiatrists 27 Podiatrists Group 28 Portable X-ray 29 Prosthetists 29 Prosthetists Group
5 Type Code Type Description 29 Prosthetist & Orthotist 29 Prosthetist & Orthotist Group 30 Ground Medical Transportation Emergency 30 Ground Medical Transportation Non-Emergency 31 Psychologists 31 Psychologists Groups 32 Certified Acupuncturist 32 Certified Acupuncturist Group 33 Genetic Disease Testing 35 Rural Health Clinic 35 P.L Rural Health Clinics & Federally Qualified Health Centers (FQHC) 37 Speech Therapists 37 Speech Therapists Group 38 Air Ambulance Transportation Services 39 Certified Hospice Service Per AB Free Clinics 41 Community Clinics 42 Chronic Dialysis Clinics 43 Multispecialty Clinics 44 Surgical Clinics 45 Exempt from Licensure Clinics 46 Rehabilitation Clinics 48 County Clinics Not Associated w/hospital 49 Birthing Center-Primary Care Clinic 50 Genetic Counseling Services 51 Outpatient Heroin Detoxification Center 52 Alternative Birth Centers Specialty Clinics 53 Breast Cancer Early Detection Program (BCEDP) 54 Expanded Access to Primary Care Clinics 55 Local Education Agency 56 Respiratory Care Practitioner 57 EPSDT Supplemental Services 57 EPSDT Supplemental Services Group 58 Family Planning 58 Health Access Program 59 Congregate Living Health Facility 60 County Hospital Inpatient Contract Through Date
6 Type Code Type Description 60 County Hospital Inpatient Non-Contract Through Date 60 Inpatient Contract Hospitals L.A. County Waiver Through Date 60 Special "Shell" Number for "Disproportionate Share" Through Date 60 Transitional Acute Care Hospital/General Acute Care Hospital Through Date 61 County Hospital Outpatient 62 Group Respiratory Care Practitioners 63 Licensed Building Contractor 64 Employment Agency 65 Pediatric Sub Acute Care LTC 65 Pediatric Sub Acute Care 66 Personal Care Agency 67 Individual Nurse 68 HCBS Benefit 69 Professional Corporation 72 Mental Health Inpatient Through Date 73 AIDS Waiver Services 74 Multipurpose Senior Services Program (MSSP) 75 Indian Health Services California Children's Service/Genetically Handicapped Person Program Non-Institutional California Children's Service/Genetically Handicapped Person Program Institutional Through Date 82 Licensed Midwife (LMW) Independent Diagnostic Testing Facility (IDTF) Crossover Only Assisted Living Waiver Pilot Project (ALWPP) Residential Care Assisted Living Waiver Pilot Project (ALWPP) Care Coordinator 95 Private Non-Profit Proprietary Agency 96 Licensed Building Contractor 97 Employment Agency
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