Gearing Up for ICD-10
We are happy to inform you that we are right on track for the implementation date of October 1, 2015. With the final days ahead, we would like to offer these few reminders from our company to you, our providers, to help things come together:
- Dual use of ICD-9 and ICD-10 will not be accepted for the same claim
- If date of service spans the implementation date of 10-1-2015, the claim will need to be split.
- For date of service on inpatient claims that will span 10-1-2015, PEHP will take the admit date as determination for ICD-9 or ICD-10.
- DX criteria for preauthorization will be based upon date of service established in the preauthorization. If establishing a preauthorization for services to be rendered post 10-1-2015, the DX code should be code ICD-10.
- PEHP will be following CMS’s guidelines for the first 12 months and will not deny claims based solely on the specificity of the ICD-10 diagnosis code as along as a valid code from the same diagnosis family is used.