Posted By Monique Dever On February 3, 2015

Learn what it means for billing and payments under ICD-10-CM rules

ICD-10-CM Codes

Two things you should do now to get ready for ICD 10 switch over on October 1, 2015. Learn what it means for billing and payments under ICD-10-CM rules.

Public health billing staff and all healthcare centers have huge changes in billing coming down the pike! And there is no rollover or trial period.


Per the Centers of Medicare and Medicaid Services (CMS), when October 1, 2015 rolls around there will be an exact cutoff for ICD-9-CM to ICD-10-CM usage for billing services, much like flipping the switch to turn your lights on. ICD-9-CM codes will no longer be accepted for electronic or paper claims on or after that date.


Claims that contain ICD-9-CM codes for service will be rejected, returned to provider, or returned as unable to process. Returned and rejected claims will be accompanied with an explanation of errors and may be corrected and resubmitted as a new claim within the timely filing period. Paper form claims that have been returned as unable to process may not be appealed, although there are some minor exceptions.


While ICD-9-CM codes cannot be used after October 1, 2015, ICD-10-CM codes cannot be used prior to October 1, 2015. Therefore, in instances that services are provided both before and after the October 1st changeover, the services must be split into two claims and filed separately. In addition, no claims can contain both ICD-9-CM and ICD-10-CM/PCS codes.

No doubt, transition to ICD 10 is major a change. However, here are two things you can do to prepare for the transition to ICD 10:


  1. Learn & Adopt: Make sure your staff is trained on ICD 10. Take opportunity to attend formal courses and learn the differences between ICD 9 and ICD 10. Create a small working group (of clinicians and billing folks) within your department to look at most frequently used codes. Create a mapping guide or cheat sheet of ICD 9 and ICD 10 codes for most frequently used codes in your clinic. Do some sample existing claims in ICD 10 to get your team is familiar with ICD 10. Do all this before ICD 10 date of 1st Oct 2015. There are no short cuts: focus and practice makes perfect.
  2. Leverage EHR Technology: In complex situations like transition to ICD 10 (with thousands of code), software and EHR can be your friend or nightmare. Make sure that EHR you use is ready well before the switch over date. A good EHR software will help your team do the learning by simultaneously showing old ICD 9 codes and new ICD 10 codes, say, six months prior to national cutoff date. Simultaneous display of ICD 9 and ICD codes will help your staff get familiar prior to switch over. Modern EHR also uses Google™-like Auto Learn and Auto Suggest technology. Such EHR technology, for each user, will remember most frequently used ICD 10 codes and offer that as a choice. No frustrating scrolling or drop downs to look for right ICD 10 code, EHR will remember your most frequently used ICD 10 codes.



Sure, change to ICD 10 is going to take a lot of effort and, at times, it will be frustrating for your staff. So start a project to learn ICD 10 and adopt to your clinic. Get acquainted with the details of ICD-10-CM. Know what you’re facing and prepare ahead of time. Read the full CMS details on billing and payments.

About Monique Dever

Monique integrates research and networking with her passion for health and well-being to provide important, up-to-date news, resources and current events to the public health communities. She is the Marketing Executive for Patagonia Health, an Electronic Health Records (EHR) software company focused on the public health sector.