Health Information Management

Tip: Check claims submitted during the ICD-10 transition

APCs Insider, December 18, 2015

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Providers should also make sure claims submitted over the ICD-10 transition date of October 1 are properly submitted. If a patient came in September 30 and left October 1, that needs to be on two claims.
Providers should split the claims so that services provided before October 1 are submitted on one claim with only ICD-9-CM codes. Services provided on or after October 1 should be on a different claim with only ICD-10-CM codes.
CMS added two ICD-10-CM codes to the list of male diagnoses:
  • Z87.430, personal history of prostatic dysplasia
  • Z87.438, personal history of other diseases of male genital organs 
CMS removed two ICD-10-CM codes from the list of male diagnoses:
  • Z80.42, family history of malignant neoplasm of prostate
  • Z80.43, family history of malignant neoplasm of testis 
CMS removed one ICD-10-CM code from the list of female diagnoses: Z80.41 (family history of malignant neoplasm of ovary).
For a full list of ICD-10-CM code edit changes, see the October I/OCE release. All changes involving these ICD-10-CM codes have an effective date of October 1, 2015.


This tip is adapted from “NCCI logic could lead to no payment for claims including comprehensive APCs” in the December issue of Briefings on APCs.

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