Completing the Transition to ICD-10
In accordance with the U.S. Department of Health and Human Services (HHS) mandate, valid ICD-10 codes are required on claims submitted to Blue Cross and Blue Shield of Montana (BCBSMT) for dates of service or inpatient discharge dates on or after Oct. 1, 2015. ICD-10 codes also are required for benefit preauthorization requests submitted on or after Oct. 1, 2015. Use of other codes, such as Current Procedural Terminology (CPT®), HCPCS and Revenue Codes, is not affected by the transition to ICD-10.
Here are some key points to keep in mind:
- Use of ICD-10 is federally mandated. All Health Insurance Portability and Accountability Act (HIPAA) covered entities must comply, regardless of each patient’s type of health insurance.
- Coding directly in ICD-10 is encouraged. Coding in ICD-9 and mapping to ICD-10 may be seen as an interim solution, but is not recommended as a best practice.
- ICD-10 is date of service/discharge date driven. Resubmission or adjustments of previously filed claims must be submitted with the code set used on the original claim.
- Only one code set per claim is allowed (all ICD-9 or all ICD-10). Claims that contain both ICD-9 and ICD-10 codes will not be accepted.
- Non-compliant claims may be rejected by your clearinghouse before reaching BCBSMT. You will need to watch electronic reports and work with your clearinghouse to correct and submit affected claims.
Visit the ICD-10 page in the Standards and Requirements section of our website for answers to frequently asked questions , among other resources. Also watch the News and Updates for announcements, such as dates and times of educational webinars. If you need assistance with ICD-10 questions, email us or contact your Provider Network Representative.
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