September 11, 2015
As previously announced in Subject Number 046-485, Subject Number 046-560 and Subject No. 046-746, the Workers’ Compensation Board (Board) intends to adopt the use of ICD-10 on a timetable consistent with the Centers for Medicare and Medicaid Services (CMS). CMS has released a statement advising that the implementation is scheduled for October 1, 2015.
To promote consistency between medical systems and to avoid imposing significant costs to support multiple systems, the Board will require use of ICD-10 consistent with CMS for dates of service after 10/1/15. In the event that the CMS October 1, 2015 implementation date is postponed, the Board will adopt an implementation timeline that is consistent with the revised timeline announced by CMS.
The Board offers the following guidance with respect to its implementation of ICD-10.
- Providers may not submit a combination of ICD-9 and ICD-10 codes on the same bill. Separate bills must be submitted for dates of service on or before September 30, 2015 and on or after October 1, 2015.
- In the event a provider has not completed the full transition to ICD-10, medical bills shall be processed and paid regardless.
- Carriers must accept both ICD-9 codes and ICD-10 codes effective October 1, 2015. Provider miscoding, such as the use of ICD-9 codes for dates of service on or after October 1, 2015, or the use of ICD-10 codes for dates of service prior to October 1, 2015, are not valid reasons to deny or reduce a medical bill.
- In order to ease the transition to ICD-10, the Board will accept the CMS-1500 (or HCFA-1500) form with a detailed narrative report or office note effective October 1, 2015. Authorized physicians, podiatrists, and chiropractors statewide may submit a CMS-1500 with a detailed narrative report or office note in lieu of C-4 or C-4.2 forms. If a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A narrative report or office note is considered detailed when it contains the necessary information for the insurance carrier to properly process the submission. The narrative attachment requirements can be found on the Board’s website.
Testing for XML submission of forms will be available to XML Submission Partners in the near future. The Board will post a test plan and test schema on the Board’s website. Please contact the Board at firstname.lastname@example.org to make arrangements for testing.
The Board continues to be available to provide support to stakeholders and to respond to inquiries regarding the transition to ICD-10. Inquiries can be sent to email@example.com. In addition, the CMS website continues to be an excellent resource for ICD-10 information. The latest information, timelines and resources can be found on the CMS website at www.cms.gov/icd10 .
Robert E. Beloten