ICD-10 billing codes and implementation
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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.
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.
To help providers navigate the codes used in provider guides, we made program-specific crosswalks of ICD-9 and ICD-10 codes.
Note: This is not a comprehensive equivalency mapping of all ICD-9 and ICD-10 codes. These are policy-specific mappings within specific programs.