On October 1, 2015, all HIPAA-covered entities—including most payers—must switch from ICD-9 to ICD-10. This means that claims for dates of service on or after October 1 must contain ICD-10 codes. However, workers’ compensation and auto insurance carriers are not HIPAA-covered entities; thus, they are not required to accept ICD-10 codes. On October 1, Therabill will default to sending ICD-10 codes for all dates of service on or after 10/1/2015.
Changing the transition date for a specific payer
When we created our ICD-10 transition rules, we assumed that some payers wouldn’t make the transition to ICD-10 on October 1. Thus, we’ve allowed you to edit the actual transition date for each of your payers. For example, maybe you submit to a workers’ comp payer that actually will begin accepting ICD-10 codes on October 1, and you need to change the default. Or, maybe one of your payers had to put off the transition until November 1.
How to change the ICD-10 transition date for a specific payer in your payer list
To change the ICD-10 transition date for a payer in your payer list,
- Hover your mouse over “Billing” in the top navigation bar of Therabill.
- Select “Insurance List” from the dropdown menu.
- You will see a list of your payers, as shown in the image to the right. As indicated by the red arrow, each payer has an ICD-10 transition message that includes the payer’s expected date of transition. This date defaults to October 1, 2015, for all payers except workers’ comp and auto insurances. For those insurances, the ICD-9 will continue to be the default until you indicate otherwise.
- To change the date for a specific payer, find that payer in your list; then, click the Info & Settings link associated with that payer.
- The payer’s settings will open up, as shown in the image at the bottom-right of this page. To navigate to the general settings, click the General tab at the top of the page.
- In the ICD-10 Transition Settings area, change the Use ICD-10 starting date to the date you want this payer to begin using ICD-10, as indicated by the blue arrow in the image at the bottom-right of this page. To continue using ICD-9 indefinitely (i.e., until you supply a date), leave the date box blank.
- Click the Save Changes button at the top of the page to save your changes.
Therabill will automatically send the ICD-10 codes that you’ve entered for the patient for all dates of service on or after the ICD-10 transition date for the payer. Therabill also will automatically split your claims based on transition date (i.e., submit separate claims for ICD-9 and ICD-10). This means that when you are creating a claim, you can still select all dates of service (even if they span the transition date), because Therabill will create multiple claims based on the ICD-10 transition date.
Entering the Correct Diagnosis Codes
Beginning on a payer’s transition date, you’ll need to start entering ICD-10 codes for all patients with that payer. You can continue to enter both ICD-9 and ICD-10 codes for all of your patients if you wish. However, when you submit the claim, it must contain codes from the correct code set (e.g., ICD-9 or ICD-10) in order to receive payment. For more information on entering ICD-9 and ICD-10 codes, please see: Entering ICD-9 and ICD-10 codes in Therabill.