ICD-10 billing codes and implementation

When to use ICD-10 codes

For claims with dates of service prior to October 1, 2015, providers must bill using ICD-9 codes.
For claims with dates of service on and after October 1, 2015, providers must bill using ICD-10 codes.

CMS flexibility guidance does not apply to HCA providers

The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) released guidance allowing flexibility in certain areas to help providers get ready for ICD-10. We have reviewed this guidance and determined the following:

  • The guidance applies to Medicare Part B claims only. It is optional for state Medicaid agencies and all organizations other than Medicare.
  • The claims processing is very similar to our current process. However, we will not allow random codes within a family of codes to be accepted as accurate coding.
  • We expect you to submit specific diagnosis codes. The codes you select must accurately describe the medical or clinical condition and comply with ICD-10 validity.

ICD-10 code equivalency mappings

To help providers navigate the codes used in provider guides, we made program-specific crosswalks of ICD-9 and ICD-10 codes.

Approved diagnosis codes by program

Note: This is not a comprehensive equivalency mapping of all ICD-9 and ICD-10 codes. These are policy-specific mappings within specific programs.

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