EDI ICD-10 Implementation Guidelines For Security Health Plan Providers
EDI ICD-10 code sets are used to report medical diagnoses and inpatient procedures. In 2015 EDI ICD-10 replaced ICD-9. Use of EDI ICD-10 versus ICD-9 on claims is based on dates of service—not on dates that claims are submitted. For dates of service on or after October 1, 2015, providers should use ICD-10 codes. For hospital inpatient claims, use date of discharge rather than date of service to determine whether to code in ICD-10 or ICD-9. When billing electronically, send a “BK” indicator for ICD9 codes and an “ABK” indicator for ICD10 codes.
ICD-9 or ICD-10 on the paper claim forms (CMS-1500 and UB-04)
Field 21 of the CMS1500 form gives providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes on the form, using a single-digit numeric value in the top right of the field. The UB-04 form includes a space for the version indicator in field 66. For both forms, the valid values for these qualifiers are “0” and “9.” An indicator of “9” means that all diagnosis codes that follow are in ICD-9 and an indicator of “0” means that all diagnosis codes that follow are in ICD-10. There is only one ICD indicator per form, and providers cannot mix ICD-9 and ICD-10 codes on the same claim form.
ICD-10 qualifier Documentation
EDI Electronic claims
Code Qualifiers: In the electronic claim, the ICD version indicator is in the HI – Health Care Diagnosis Code segment. Ø Professional Claim (837P) ICD Code Set Qualifiers: HI – Health Care Diagnosis Code segment / loop 2300 ABK = ICD-10-CM – Principal Diagnosis BK = ICD-9-CM – Principal Diagnosis ABF = ICD-10-CM – Diagnosis BF = ICD-9-CM – Diagnosis
Paper claims
Field 21 of the CMS1500 form gives providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes on the form, using a single-digit numeric value in the top right of the field. The UB-04 form includes a space for the version indicator in field 66. For both forms, the valid values for these qualifiers are “0” and “9.” An indicator of “9” means that all diagnosis codes that follow are in ICD-9 and an indicator of “0” means that all diagnosis codes that follow are in ICD-10. There is only one ICD indicator per form, and providers cannot mix ICD-9 and ICD-10 codes on the same claim form.