Outpatient Facility Coding Alert - 2011 Issue 11
ICD-10: Do This When DOS Spans ICD-9/ICD-10 Implementation Date
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Article Overview
This article summarizes CMS guidance for claims that span the ICD-9/ICD-10 transition date. It is aimed at coders, billing staff, and providers who need to understand general claim-handling expectations for different facility and service categories when the date of service crosses the implementation boundary. The article references CMS transmittal guidance and discusses broad claim-processing outcomes such as split reporting and return-to-provider handling, without getting into detailed coding policy beyond the transition issue.
Why This Topic Matters
Claims that span the ICD-9/ICD-10 implementation date can be processed differently depending on provider type and date logic. Understanding the general guidance helps reduce rejected or returned claims and supports cleaner billing during a major coding transition.
Article Sections
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Distinguish "from" and "through" dates
Introduces the date-of-service issue when a service begins before and ends after the ICD-10 implementation date. It frames the claim-processing question for transition-period services.
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Follow Guidance
Summarizes CMS-issued guidance and notes that reporting expectations vary by provider type. It references a transmittal that outlines how claims spanning the transition date are handled.
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Inpatient hospitals
Addresses the general claim timing approach for inpatient hospital services when discharge or through dates fall after the transition date.
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Providers, Part B hospital services, outpatient hospitals, hospices, and outpatient home health
Describes the broad split-claim approach for several non-inpatient provider categories during the transition period.
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Expect return, not denial
Explains the general processing outcome when claims contain transition-period date issues and notes that the article includes a sample return message.
What You Will Learn
- How CMS addressed claims that span the ICD-9 to ICD-10 implementation date
- Which broad provider categories are discussed in the transition guidance
- How date-of-service logic affects claim handling during the coding transition
- What general claim-processing outcome may occur when the wrong diagnosis code set is used for the service date
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Providers
- Claims specialists
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