Provider Notice Issued 06/17/15

ICD-10-CM Implementation - Claim Submission Requirements

This notice serves to inform providers of specific claim information required as a result of the federally-mandated conversion from the ICD-9-CM code set to the ICD-10-CM code set effective October 1, 2015. These instructions do not apply to dental claims billed on the ADA claim form to the department’s dental program contractor, DentaQuest of Illinois.

General Information   

• HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM diagnosis codes on the same claim.

• HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM procedure codes on the same claim.

837 Professional and Paper Claims

• ICD-9-CM diagnosis codes will no longer be accepted on electronic and paper claims with service dates on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. The department is revising paper claim forms HFS 2210 (durable medical equipment and supplies); HFS 2211 (laboratory/portable X-ray); and HFS 2212 (health agency) to accommodate expanded ICD-10 diagnosis coding. For providers who bill on these claim forms, paper claims with ICD-10 diagnosis codes with dates of service on or after October 1, 2015 must be billed on the revised forms. These revised forms will have a revision date of R-2-15 in the bottom left corner of the form and may be ordered beginning in August, 2015, from the Medical Forms Request page of the department’s website.

• For claims with dates of service prior to October 1, 2015, submit with the appropriate ICD-9-CM codes. Either the current version or the revised version of the paper HFS 2210, HFS 2211, and HFS 2212 can be used to submit claims with ICD-9 diagnosis codes.

• Claims for certain items or supplies (such as equipment rentals or monthly supplies) should be split based on service dates pre- and post-October 1, 2015.

837 Institutional and Paper Claims

• ICD-9-CM diagnosis and procedure codes will no longer be accepted on electronic and paper claims with dates of discharge or Through Dates of service on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. Exception: Claims for emergency department and observation that span October 1, 2015 should not be split. The appropriate ICD-9-CM diagnosis code should be used based on the service From Date.  

• For claims with dates of discharge or Through Dates of service prior to October 1, 2015, submit with the appropriate ICD-9-CM codes.

• Series claims should be split based on service dates pre- and post-October 1, 2015.

• All per diem-reimbursed claims that span October 1, 2015 must be split based on service dates pre- and post- October 1, 2015.

• All DRG-reimbursed claims that span October 1, 2015 must be billed admission through discharge.

eQ Health Review - Inpatient Per Diem Reimbursed Stays Crossing October 1, 2015

Per diem reimbursed claims that are subject to continued stay review by the department’s Quality Improvement Organization, eQHealth Solutions, Inc., must be split pre- and post-October 1, 2015. Hospitals must get certification for the days prior to October 1, 2015, and also for the days after October 1, 2015.

Per diem reimbursed interim claims (those with a FL 4 Frequency Digit of 3 or 4) that contain a From Date on or after October 1, 2015 cannot contain an Admission Date prior to October 1. The department is modifying its edits for this situation to allow hospitals to bill an interim claim that contains an Admission Date of October 1, 2015.  

Questions pertaining to professional billing may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565, Option 3. Questions pertaining to institutional billing may be directed to the Bureau of Hospital and Provider Services at 1-877-782-5565, Option 2.

Felicia F. Norwood

Director