December 1, 2011

Official ICD-10 Coding and Claims Processing Guidance Now Available


Two years from now, ICD-10-CM/PCS will be implemented in the United States. As we get closer to the Oct. 1, 2013 implementation date, more and more valuable resources are being posted online. Many of these resources are available for free, and with all of the expenses that ICD-10 implementation will bring, providers would be wise to make use of any and all ICD-10 resources readily available to the general public. Examples of two such resources are detailed below.



Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing ICD-10

This Medicare transmittal has an implementation date of Jan. 3, 2012, and it can be downloaded at

For dates of service on and after Oct. 1, 2013, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the ICD-10 code sets in standard transactions adopted under HIPAA. ICD-9-CM codes no longer will be accepted on electronic or paper claims with "from" dates of service or institutional claims/professional and supplier claims with "dates of discharge/through" dates of service on or after Oct. 1, 2013. A claim cannot contain both ICD-9-CM codes and ICD-10 –CM/PCS codes. Institutional claims will be returned to provider (RTP). Professional and supplier claims will be returned as unable to be processed.

In the aforementioned transmittal, the Centers for Medicare & Medicaid Services (CMS) has identified potential claims processing issues for institutional, professional and supplier claims that span the implementation date; that is, claims for which ICD-9-CM codes are effective for services rendered on Sept. 30, 2013 and earlier and ICD-10 codes are effective for services rendered on Oct. 1, 2013 and later. In some cases, depending on the policies associated with those services, there cannot be a break in service or time (for example, when administering anesthesia), although the new ICD-10 codes set must be used effective Oct. 1, 2013.

This transmittal also provides details on what courses of action will be required if claims from institutional facilities, practitioners or suppliers are submitted for processing and the claims/services span the "before" and "after" of the implementation date.


ICD-10-CM/PCS Official Coding Q&A Forum

During the Nov. 17, 2011 ICD-10 Implementation Strategies and Planning National Provider Call, Nelly Leon-Chisen, RHIA, director of coding and classification for the American Hospital Association (AHA), announced that the AHA will publish the "Coding Clinic for ICD-10-CM ." This publication will provide official ICD-10-CM/PCS coding guidance similar to what currently is provided in the quarterly publication "AHA Coding Clinic for ICD-9-CM."

AHA has no plans to translate all previous issues of Coding Clinic for ICD-9-CM into ICD-10-CM/PCS since many of the published questions arose out of the need to provide clarification on the use of ICD-9-CM, and would not be readily applicable to ICD-10-CM/PCS.

The AHA Coding Clinic for ICD-10-CM also will be supported by the Cooperating Parties for ICD: specifically, the AHA, CMS, the National Center for Health Statistics (NCHS) and the American Health Information Management Association (AHIMA).

During the Nov. 17 call, Leon-Chisen also announced that, effective immediately, coding questions about ICD-10-CM and ICD-10-PCS will be accepted by the AHA Central Office and Sue Bowman at AHIMA. The contact information is as follows:

The AHA Central Office

155 North Wacker Drive, Suite 400
Chicago, IL 60606
Phone: 312-893-6800
Requests for Coding Advice should be faxed to 312-278-0838.

Sue Bowman, RHIA, CCS
Director of Coding Policy and Compliance



A forum for submitting ICD-10-CM/PCS questions will be welcomed by many in the coding community. For example, some coding managers have turned on the feature in their encoder software that allows coding specialists simultaneously to generate ICD-10-CM/PCS codes while also assigning ICD-9-CM codes. However, the use of the ICD-10 encoding logic has resulted in a number of questions about the appropriate coding of certain diagnoses and procedures. In addition, a number of ICD-10 trainers have identified specific coding questions based on their training/educational experiences.

How and when answers to ICD-10-CM/PCS questions will be communicated will be announced in the near future, according to Leon-Chisen.

For the Nov. 17 National Provider Call handout, go online to



Read 161 times Updated on March 16, 2016
Lolita M. Jones, MSHS, RHIA, CCS

Lolita M. Jones, MSHS, RHIA, CCS has provided Product Consultant services to a warehousing and analytics start-up that developed and marketed decision support software, health outcomes services, and regulatory compliance toolsets. Her goal is to combine her medical coding expertise with data mining-pattern recognition, to help improve data accuracy and compliance in medical coding and reimbursement (i.e., ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, modifiers, DRGs, APCs, and eAPGs). Ms. Jones also provides remote and on-site training/consulting in her newly developed Healthcare Data Mining Clinic educational series. She is currently pursuing a Graduate Certificate in Healthcare Data Analytics from a top university. Ms. Jones is based in New York and can be reached at .