Physician Practice

CMS guidance clarifies instructions for reporting services spanning October 1

Physician Practice Insider, October 6, 2015

Providers need to report all services from October 1 forward with ICD-10 codes, but many will likely face scenarios with patients whose dates of service begin prior to October 1 and end after implementation. CMS has released special guidance to clarify how those instances would be billed with each bill type in MLN Matters® SE1325.

On a Type of Bill (TOB) 12X for reporting inpatient Part B hospital services, CMS requires providers to split claims so that all ICD-9-CM codes remain on one claim with dates of service through September 30. All claims with dates of service beginning October 1 or later are required to be reported with ICD-10 codes. Providers should use the “from” date to determine the dates of service, not the “through” date.

For TOB 11X with inpatient hospital services, if the claim has a discharge and/or through date on or after October 1, the entire claim should be reported with ICD-10 codes.

CMS has included example bills for ED and observation services in MLN Matters SE1325 and recommends providers check with individual payers to determine how they will handle claims that split the implementation date.

For more information, CMS has also released MLN Matters SE1408 with additional guidance.

This article originally appeared in

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