ICD-10 Diagnosis Codes Delayed by CMS through October 1, 2015
Roy Franco
May 21, 2014

Earlier this year, Congress passed the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) which included amongst the various provisions a requirement prohibiting the Secretary of Health & Human Services from replacing ICD-9 Diagnosis codes prior to October 1, 2015.  As a consequence of that law, CMS issued a Technical Alert last week to discuss the delayed implementation of ICD-10 diagnosis codes by Responsible Reporting Entities (RREs) for Medicare Secondary Payer reporting.

Effective immediately, RREs are to postpone reporting ICD-10 diagnosis codes on their production Claim Input File submissions until October 1, 2015.  Previously, CMS had accepted voluntary reporting of these codes, which now begs the questions of whether RREs are required to update these records to the required ICD-9 codes.  We have posed that question to our EDI representative on behalf of our reporting clients and will immediately advise of any impacted changes.  We suspect the biggest issue is for claims reported as ORM, that were not terminated before this Technical Alert was issued.  These records would be actively reviewed by CMS for coordination of benefits, and it is unclear how CMS will interpret the ICD-10 diagnosis codes previously submitted for coordination of benefits and may require a larger number of disputes to be filed with the contractor for care unrelated to the claim.
Prior the new law, CMS had announced  to RRE’s that they could voluntarily report ICD-10 diagnosis codes for production Claim Input Files submitted after October 1, 2014; and was required to completely convert over to ICD-10 diagnosis codes by April 1, 2015.  This is no longer the case, and regrettably, we see added work for claim administrators as they sort out the right data to input for these diagnosis codes.  The real issue for the RRE will be whether or not the Providers are allowed to voluntarily push ahead with the use of ICD-10 codes for billing purposes.  This change in the law not only took CMS by surprise, but many providers who are too far down the track to possibly revert back to ICD-9 codes.  Two articles published by IT security is of interest in this regard.  Depending on which way CMS goes, will determine whether RREs will be faced with provider bills that have ICD-10 codes that will require translation to the ICD-9 table.  Since there is not exactly a one to one relationship going from ICD-10 to ICD-9, the results could be very interesting, and be yet another factor that will increase potential disputes.  Click here  and here for these IT security articles.  Should providers proceed with ICD-10 reporting processes, claims personnel, will need to be able to decipher ICD-10 codes to ICD-9 codes, as MMSEA Section 111 reporting does not allow for a reported claim record to have both ICD code versions.
According to the Technical Alert, beginning October 1, 2015, a little over a year from now, RREs will be able to:
  • ICD-10-CM diagnosis codes will be required on all production Claim Input Files add and update records with a CMS Date of Incident (DOI) of October 1, 2015 and subsequent.
  • ICD-9-CM or ICD-10-CM diagnosis codes will be accepted on all add and update records with a CMS DOI prior to October 1, 2015.

Franco Signor will continue to monitor this transition to ICD-10 code implementation and share with our clients and friends any insights and details about how this program will impact required reporting under the Medicare Secondary Payer Act.