Medicare Compliance & Reimbursement - 2015 Issue 11
Reader Question: Avoid ICD-9 and ICD-10 on 1 CMS-1500 Form
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Article Overview
This article addresses a billing question about claim submission when a patient encounter spans the ICD-10 transition period. It is aimed at coders, billers, and practice staff who need to understand the general handling of cross-over dates on a CMS-1500 claim and the related Medicare guidance referenced in the discussion. The piece summarizes the issue, the need to separate services by date period, and a special anesthesia exception, without serving as a full coding manual.
Why This Topic Matters
Cross-over dates can affect whether a claim is accepted for processing, so understanding the transition-period guidance helps prevent returned claims and delays in reimbursement.
What You Will Learn
- How claim dates spanning a major diagnosis-code transition are handled at a high level
- Why separate claims may be needed when services fall on both sides of an implementation date
- What general type of exception is noted for certain anesthesia claims
- Which Medicare guidance source is referenced in the discussion
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Hospital billing staff
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