authorization with an ICD-9-CM code for a DOS before 10/1/2015, but then change the patient’s visit to a date after 10/1/2015, am I required to get a new authorization?
Yes. If you change the DOS to a later date after ICD-10-CM implementation, you will need to get a new authorization.
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Is there going to be a new CMS 1500 form?
According to the CMS, it will accept only the
revised 02-12 CMS-1500 form as of April 1, 2014.
CMS has not indicated a revision to the current form. You can visit www.CMS.gov for additional information.
If we have a pregnant patient who comes into the office, and we get an authorization for her pregnancy before 10/1/2015, does this mean we have to get a new pregnancy authorization after 10/1/2015?
No, you will not have to update the authorization.
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For durable medical
equipment (DME) rentals, will I need to get a new
authorization for service that spans 10/1/2015?
For services starting before 10/1/2015, complete the authorization using the ICD-9-CM code. We will require no updates even though you will
provide some of the services after 10/1/2015. For services that begin 10/1/2015, you should get authorization using ICD-10-CM codes.
Where do we find the new ICD-10-CM DX codes?
There are many places on the Web where you can find ICD-10-CM code information. Washington Publishing Company (www.wpc-edi.com) provides hardcopy manuals for a cost. You can also visit www.ICD10Data.com, a free medical coding website for current and accurate ICD-10-CM/PCS codes. These sites are not managed by BlueCross BlueShield of South Carolina and BlueChoice
HealthPlan. The sites are solely responsible for the
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Will diagnosis and procedure codes change or remain the same?
ICD-10-CM codes will change. There are no plans at this point to address procedure (CPT) coding.
The mandate is specific to ICD-9-CM diagnosis and procedure codes converting to ICD-10-CM.
CPT coding is a completely different code set and is not addressed in this mandate.
Do you process claims by DOS or date of claim
submission?
We process claims by DOS.
If we authorize for a DOS prior to 9/30/2015, but the DOS
changes to a new date after 10/1/2015, do you require a new authorization?
Yes. If you change the DOS to a later date after ICD-10-CM implementation, you will need to get a new authorization.
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If we submit a claim with ICD-9-CM and ICD-10-CM codes, is the authorization going to be valid?
Yes, the authorization will be valid. Remember that you will need to file ICD-9-CM codes on a separate claim from the ICD-10-CM codes.
Should we normally request the diagnosis code along with the CPT code for
authorization?
You should always request the diagnosis code when getting an authorization.
Is a level of care and plan of care the same thing? I work for a physical, occupational and speech therapist who uses plan of care.
They are different. The level of care applies to inpatient claims for a skilled nursing facility. The plan of care refers to the treatment plan.
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Does the ICD-10-CM affect dental codes at all?
This change impacts all dental claims you file through the patient’s medical benefit. An example of a dental/oral surgical procedure that we may cover under medical is the extraction of an impacted tooth.
Will BlueCross require
external mechanism codes on a claim when we submit ICD-10-CM codes for fractures, sprains or strains?
The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM.
Will we be able to appeal claims filed with ICD-9-CM codes with DOS after
10/1/2015?
If you receive a denial on a claim because you filed an ICD-9-CM code instead of the ICD-10-CM code, you can file a corrected claim with the ICD-10-CM code to have us reconsider the claim for
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What happens if we only submit the ICD-10-CM code for fractures, strains or sprains?
You have to report the appropriate ICD-10-CM code that includes the reference to the external cause of injury when you submit the claim. For example, the ICD-9-CM code 814.09 is closed fracture of other bone of wrist. This same condition is converted to ICD-10-CM as S62.153A,
displaced fracture of hook process of hamate [cuneiform] bone, unspecified wrist, initial encounter for closed fracture.
Will BlueCross follow Medicare’s one year
allowance to accept all claims as long as the code is in the
“code family”?
No. We are expecting providers to file with the appropriate coding. CMS is only providing a grace period on “penalties” associated with incorrect filing. CMS also expects correct coding.
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Is the decimal required when submitting codes?
Yes, we require the decimal when you submit claims through the Web. The decimal is omitted from ICD-9 and ICD-10-CM in the electronic claim and the paper UB-04. It is optional on the CMS-1500 and the ADA-JD430.
Do you require us to file all ICD-10-CM codes with seven alphanumeric characters?
Certain ICD-10-CM categories have applicable seventh characters. We require the applicable seventh character for all codes within the category, or as the notes in the Tabular List instruct. The seventh character must always be the seventh character in the data field. If a code that requires a seventh character is not six characters, you must use a placeholder X to fill in the empty characters.
You can find additional ICD-10-CM coding guidelines at
https://www.cms.gov/Medicare/Coding/ICD10/Dow
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How will you communicate to providers any issues with ICD-10-CM implementation? If something goes wrong, will BlueCross send information and updates, or will providers have to go to your website?
We will add bulletins to
www.SouthCarolinaBlues.com and
www.BlueChoiceSC.com. Our Provider Services call center will also include any ICD-10-CM
announcements via the voice response unit (VRU).
Are we allowed to submit ICD-9 and ICD-10-CM codes
together on a claim?
No, you cannot file a claim with both ICD-9 and ICD-10-CM codes. You will need to file with ICD-9 codes on one claim, and file with ICD-10-CM codes on a separate claim.
What does the “F” in front of the ICD-10-CM code signify?
Each alphanumeric digit corresponds to a category (family) of codes in the ICD-10-CM manual. The
“F” is assigned for mental and behavioral health disorders.
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Please explain the qualifier in block 21. Do we enter that on the hardcopy claim?
Our preferred method is for you to submit claims to us electronically. We have a website available for you to key claims if you do not have systems programmed to electronically submit to us. If you are filing your claims hardcopy, you should indicate ICD-10-CM coding with a “0” in block 21.
Are any medical policies going to change?
We review and update medical policies annually, but we updated these policies to include the appropriate ICD-10-CM codes that are applicable to each policy.
Why is My Insurance Manager showing a highlighted section in the template for submitting claims?
After 10/1/2015, My Insurance Manager will allow you to submit ICD-10-CM codes. We prepared the system early and have highlighted the section to prevent you from filing claims with ICD-10-CM codes prior to the compliance date.
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I am curious how ICD-10-CM will affect mental health professionals who are not Medicare or Medicaid
providers. Will it change our CPT codes or will you use it in place of DSM-5® diagnosis codes?
DSM-5 contains both ICD-9-CM and ICD-10-CM codes.
Will there be a grace period to update the level of care on an authorization?
You should update the level of care on an authorization as soon as possible.
Do you require medical records for authorizations if we don’t know the specific diagnosis code?
It depends on the service that is requested. Many times we can accept a general diagnosis code to complete an authorization. For those services that require a specific diagnosis code to authorize, we
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In a physical therapy office, do we add A, D or S to the end of the codes?
Most categories have seventh character
extensions that are required for each applicable code, and most categories have three extensions (with the exception of fractures):
A = Initial encounter (patient receiving active treatment for injury, such as surgical treatment, emergency department encounter and
evaluation/treatment by new physician)
D = Subsequent encounter (patient received active treatment of the injury and receiving routine care for injury during the healing or recovery
phase, such as cast change/removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow-up visits following injury treatment)
S = Sequela (used for complications or conditions that arise as a direct result of an injury, such as
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We are a hearing aid clinic that bills only for hearing aids. The only codes we have used are the diagnosis codes 389.17 and 389.18. The CPT codes we use most frequently are V5257 and V5261 (BTE's monaural and binaural, respectively). Are these changing? If so, can you provide the corresponding codes we need to use?
You may find the website www.icd10data.com beneficial to you to help convert your ICD-9-CM codes to ICD-10-CM codes. For the examples you’ve provided, the comparable ICD-10-CM code is H90.41 or H90.42 for ICD-9-CM code 389.17;
and ICD-10-CM H90.3 for ICD-9-CM 389.18.
ICD-10-CM codes will change. There are no plans at this point to address current procedural
terminology (CPT) coding. The mandate is specific to ICD-9-CM diagnosis and procedure codes
converting to ICD-10-CM. CPT coding is a
completely different code set and is not addressed in this mandate.