Tomorrow is the day we’ve been waiting for since August 3, 2015! For claims with start date on, or after, October 1, 2015, dual coding is no longer required. The ICD-10 transition is a requirement by the Health Insurance Portability Accountability Act (HIPAA) and all entities -including physicians, vendors, payors, etc.- are required to use the new code set. Three factors will influence your code choice: 1) the claim “FROM” date, which is the episode start date; 2) The OASIS M0090 date; and 3) the claim “through” date.
According to CMS, for initial home health episodes, the M0090 date will determine code use. When the SOC is before October 1, 2015 and the M0090 date is before October 1, ICD-9-CM codes are to be used. When the episode SOC (M0030) date is before October 1, but the M0090 date is after October 1, ICD-10-CM codes will be used on the OASIS and will be used to determine the HIPPS codes. The RAP, however, will need to be reported using ICD-9-CM codes even though ICD-10 codes are to be used on the OASIS assessment. Remember, RAPs are NOT subject to medical review and are replaced in Medicare claims history by the final claim.
For recertification episodes, the M0090 date will be used to determine code use. Since the recertification is competed up to 5 days before the start date, a recertification that will begin October 1, 2015 could have an episode start date in September. In this case, ICD-9-CM codes are used on the OASIS assessment and will be used to determine the HIPPS codes. However, both the RAP and claim will require ICD-10-CM codes since the “through” date on both will be after October 1, 2015, per official CMS guidance. The chart below should be used to determine which code set is to be used and can be found By clicking HERE.
If you’re still unsure about choosing ICD-10 codes, or want to learn how to code for home health, QIRT offers a wide variety of online education to fit your needs.
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The ICD-10 transition begins October 1, 2015 – TOMORROW!
To assist you in your professional goals, QIRT Online Complete ICD-10 Training Modules was offered at the discount price of $295, BUT TOMORROW:
ICD-10-CM Complete Training Series will increase in price to $350 at 12:01am on 10/1/15.
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If you have any questions about QIRT Education, or would like more information, please email Q&A@qualityinrealtime.com. I look forward to hearing from you soon.