ICD-10 Implementation

Volunteer Testing Form

This form must be submitted by 10/03/14 

If you are interested in testing your end-to-end ICD-10-CM transactions, please complete and submit the online Volunteer Testing Form. External

Background

Effective with dates of service on or after 10/1/15, the ICD-9 code sets will be replaced by ICD-10 code sets. To help prepare for this transition, the CMS is soliciting volunteers to conduct limited end-to-end testing with the MACs for the first round of testing, 1/26-1/30/15. The sample of 50 participants for each MAC will be selected from the volunteers to represent a broad cross-section of provider types, claims types, and submitter types. Selected testers will be notified that they have been selected by 10/24/14. Those selected will be provided specific details regarding how to test and who to contact for testing support.

The MAC systems will be able to accommodate future dates of service for this testing. Test claims with ICD-10 codes must be submitted with dates of service 10/1/15 through 10/15/15. Each selected submitter may send up to 50 test claims over the course of the testing week. Test claims accepted into the system will be processed by the MAC and a remittance advice will be generated.

For those electronic submitter/trading partners who serve in multiple states, and multiple Medicare jurisdictions, CMS reserves the right to limit a particular submitter to test with only one MAC.

Minimum Testing Requirements

All volunteers for participation in the January 2015 end-to-end testing for ICD-10 must be able to meet the following testing requirements:

  1. Testers must be established electronic submitters, with active Medicare submitter IDs, and capable of receiving ERAs to be eligible for this testing. Electronic submitters are defined as clearinghouses, billing agencies, or a professional or institutional provider that submits directly to Medicare.
  2. Providers who submit through a clearinghouse will have to work with their clearinghouse to test, if the clearinghouse is chosen for testing, and may not submit a volunteer form.
  3. Vendors cannot volunteer to test directly because they do not have a submitter ID. Vendors must work with a chosen submitter to test.
  4. Testers must be ready to test ICD-10, meaning, all vendor and practice management software needed to test has been updated and internally tested prior to conducting end-to-end testing with Medicare.
  5. Testers must be able to submit future dated claims.
  6. Testers must be able to provide the NPIs and beneficiary HICNs they will use for test claims when requested by the MAC. This information will be needed several months prior to the start of testing for set-up purposes.

Thank you for volunteering for ICD-10 end-to-end testing. You will be notified if selected.

Benefits of ICD-10

ICD-10 incorporates greater and specific data from clinical detail and specificity than ICD-9, and offers better support for care management, analytics, and quality measurement. ICD-10 will also improve the understanding of risk and severity. The modern classification system will provide much better data needed for measuring the quality, safety and efficiency of care and improve clinical, financial and administrative performance. Here are some examples of the benefits of ICD-10:

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Frequently Asked Questions

  1. Will there be structural differences between ICD-9-CM and ICD-10-CM diagnosis codes?

    Answer: Yes, there will be changes to the field length, the amount of codes available and the code composition will be different. Codes will generally be more specific and laterality is often identified.
  1. Where do we find the cheat sheets for most common codes used for certain providers?

    Answer: You can contact your specialty society, they may be able to help you with ways you can focus on the particular codes that would be most beneficial to your practice.
  1. Will the CMS-1500 claim forms be changed to accommodate the new ICD-10 codes?

    Answer: Yes, the NUCC revised the CMS-1500 claim form. The new form is version (02/12). Refer to News article “Revised CMS-1500 Paper Claim Form: Version 02/12” for additional information.

    You can visit the National Uniform Claim Committee (NUCC) website External to order the revised claim form and download the new instructions.
  1. Will we not be using lateral modifiers on the CPT codes since the ICD-10 codes will have them included?

    Answer: There is no change to appending CPT procedure code modifiers.
  1. Will CPT codes change as well?

    Answer: ICD-10-PCS (inpatient procedure coding) was developed by CMS for use in U.S. inpatient hospital settings only. The transition to ICD-10-CM PCS does not affect CPT codes, which will continue to be used for outpatient services.
  1. Will modifiers still be used?

    Answer: Yes, there is no change to the procedure of appending modifiers.
  1. Will workers’ compensation and auto insurance companies which are considered noncovered entities have to switch to ICD-10-CM/PCS?

    Answer: Workers' compensation and auto insurance companies are considered noncovered entities and are not covered under HIPAA, however since the ICD-9-CM codes will no longer be maintained after the implementation of ICD-10-CM/PCS it is recommended that that you use the new coding system.

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ICD-10 Training and Resources

MACs will not provide ICD-10 training for coding purposes. The resources provided below are for convenience only. National Government Services is not responsible for the content updates, maintenance, or fees associated with these external sites.

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Last Modified: 9/15/14