June 17, 2015
To: All Medical Assistance Program Providers
Re: ICD-10-CM Implementation - Claim Submission Requirements
This notice serves to inform providers of specific claim information required as a result of the federally- mandated conversion from the ICD-9-CM code set to the ICD-10-CM code set effective October 1, 2015. These instructions do not apply to dental claims billed on the ADA claim form to the department’s dental program contractor, DentaQuest of Illinois.
General Information HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM diagnosis codes on the same claim.
HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM procedure codes on the same claim.
837 Professional and Paper Claims ICD-9-CM diagnosis codes will no longer be accepted on electronic and paper claims with service dates on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. The department is revising paper claim forms HFS 2210 (durable medical equipment and supplies); HFS 2211 (laboratory/portable X-ray); and HFS 2212 (health agency) to accommodate expanded ICD-10 diagnosis coding. For providers who bill on these claim forms, paper claims with ICD-10 diagnosis codes with dates of service on or after October 1, 2015 must be billed on the revised forms. These revised forms will have a revision date of R-2-15 in the bottom left corner of the form and may be ordered beginning in August, 2015, from the Medical Forms Request page of the department’s website.
For claims with dates of service prior to October 1, 2015, submit with the appropriate ICD-9-CM
codes. Either the current version or the revised version of the paper HFS 2210, HFS 2211, and HFS
2212 can be used to submit claims with ICD-9 diagnosis codes.
Claims for certain items or supplies (such as equipment rentals or monthly supplies) should be split based on service dates pre- and post-October 1, 2015.
837 Institutional and Paper Claims ICD-9-CM diagnosis and procedure codes will no longer be accepted on electronic and paper claims with dates of discharge or Through Dates of service on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. Exception: Claims for emergency department and observation that span October 1, 2015 should not be split. The appropriate ICD-9-CM diagnosis code should be used based on the service From Date.
For claims with dates of discharge or Through Dates of service prior to October 1, 2015, submit with the appropriate ICD- 9-CM codes.
Series claims should be split based on service dates pre- and post-October 1, 2015.
All per diem-reimbursed claims that span October 1, 2015 must be split based on service dates pre- and post- October 1, 2015.
All DRG-reimbursed claims that span October 1, 2015 must be billed admission through discharge.
eQ Health Review - Inpatient Per Diem Reimbursed Stays Crossing October 1, 2015
Per diem reimbursed claims that are subject to continued stay review by the department’s Quality Improvement Organization, eQHealth Solutions, Inc., must be split pre- and post-October 1, 2015. Hospitals must get certification for the days prior to October 1, 2015, and also for the days after October 1, 2015.
Per diem reimbursed interim claims (those with a FL 4 Frequency Digit of 3 or 4) that contain a From Date on or after October 1, 2015 cannot contain an Admission Date prior to October 1. The department is modifying its edits for this situation to allow hospitals to bill an interim claim that contains an Admission Date of October 1, 2015.
Questions pertaining to professional billing may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565, Option 3. Questions pertaining to institutional billing may be directed to the Bureau of Hospital and Provider Services at 1-877-782-5565, Option 2.
Felicia F. Norwood
Director
Frequently Asked Questions
1. When will HFS begin to accept ICD-10 claims? HFS will start accepting claims using ICD-10 codes on October 1, 2015 for dates of service/discharge on or after October 1, 2015.
2. How will HFS determine whether ICD-10 or ICD-9 is the appropriate code set to use?
The date of service or the date of discharge for inpatient claims will be the deciding factor in determining which codes set is appropriate. If the date of service/discharge is before October 1, 2015, then ICD-9 codes should be used on the claim. For any dates of service/discharge occurring on or after October 1, 2015, use ICD-10 codes on the claim. Exception: Claims for emergency department and observation that span October 1, 2015 should not be split. The appropriate ICD-9-CM diagnosis code should be used based on the service From Dat
3. Do you plan on converting ICD-10 codes to ICD-9 codes? HFS will not convert claims. Based upon the date of service/discharge, a claim will be processed as either an ICD-10 or ICD-9. Claims without the appropriate code set for the date of service/discharge will not be accepted.
4. Will HFS still accept ICD-9 codes after October 1, 2015?
Yes, the department will still accept claims with ICD-9 codes after October 1, 2015. However, ICD-9 codes will only be accepted for claims with dates of service/discharge before October 1, 2015. Any dates of service/discharge after September 30, 2015 must use ICD-10. See Exception, Question 2.
5. Will we be able to submit an ICD-9 claim with a date of service/discharge later than October 1, 2015? No, any claim with an ICD-9 code submitted for a date of service/discharge greater than September 30, 2015 will be rejected. See Exception, Question 2.
6. Does HFS have staff dedicated to ICD-10 conversion? Yes, HFS has a dedicated team tasked specifically to ICD-10 conversion.
7. How is HFS readiness when considering ICD-10 conversion? Currently, HFS is on task and all requirements for ICD-10 conversion are on schedule. HFS will "go live" with ICD-10 on October 1, 2015.
8. When will HFS publish policy and notices concerning ICD-10? The goal of the Department is to get notices and policies concerning ICD-10 published by July, 2015.
9. Will vendors be able to test with HFS before October 1, 2015? Due to technological constraints, HFS will not be providing a platform for end to end testing for external vendors.
10. Do all HFS-enrolled providers have to use ICD-10 coding? Yes, all providers whose claims require a diagnosis code must use ICD-10 diagnosis codes on the claim. All inpatient hospital claims must use ICD-10 procedure coding as well.
