ED Coding & Reimbursement Alert - 2015 Issue 23
ICD-10: CMS: Your Payments Are Tied to CPT® Codes, Not ICD-10 Codes
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Article Overview
This article summarizes CMS guidance on the ICD-10 transition for Medicare providers, with emphasis on how the change affects diagnosis reporting, physician and outpatient claim workflows, testing options, and the separation between diagnosis coding and payment processes. It is aimed at coders, billing staff, and practices preparing for the ICD-10 implementation date, especially those working in Part B, outpatient, and office settings.
Why This Topic Matters
Understanding the scope of the ICD-10 transition helps practices prepare for claim submission changes, testing, and documentation updates without confusing diagnosis coding requirements with payment methodology. The article is relevant to organizations that need to align coding operations with CMS implementation guidance and date-of-service billing rules.
Article Sections
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ICD-10 transition and Medicare payment overview
Introduces CMS guidance on the ICD-10 transition and the relationship between diagnosis coding, claim submission, and payment processes. It frames the article around common misconceptions and implementation timing.
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Payments still tied to CPT®
Addresses CMS discussion of outpatient and office billing, claim processing, and how payment methodology is handled during the transition. It also notes testing and submission-related topics for Medicare providers.
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Outpatient coders won’t use PCS
Explains the CMS clarification about diagnosis coding versus procedure coding across care settings. It covers which provider types are affected by ICD-10-CM and ICD-10-PCS at a high level, along with date-of-service timing for billing.
What You Will Learn
- How CMS framed the ICD-10 transition for Medicare providers
- Which broad claim and reimbursement processes are affected by the change
- How outpatient and physician settings are discussed in relation to diagnosis and procedure coding
- What general testing and claim submission options were mentioned by CMS
- How date of service relates to the coding system used on a claim
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Physician practices
- Outpatient and Part B providers
- Compliance staff
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