ICD-10 frequently asked questions
On July 6, 2015, Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) announced efforts to help providers prepare for ICD-10. They published guidance that will allow for flexibility in the claims auditing and quality reporting process. This will help as the medical community gets used to the new ICD-10 code set.
Since July 6, 2015, CMS and AMA have released additional information/guidelines.
Please read our response to these guidelines
What is Aetna's approach to testing?
We have done large-scale internal testing, as well as targeted external testing. Our testing cycles were completed in mid-2015. If you have not yet tested your systems with your clearinghouse and other business partners, you should do so immediately. The compliance date is October 1, 2015.
How will the transition from ICD-9 to ICD-10 work with interim billing?
Inpatient hospital claims without a discharge date (that is, interim bill) will use the earliest claim incurred (ECI) date (earliest date of service). This will be the only determinant of which code set to accept/reject. Interim bills sent with an ECI date on or after October 1, 2015 must be submitted with ICD-10 codes. Interim bills sent with an ECI date before October 1, 2015 must be submitted with ICD-9 codes.
How will Aetna handle split claims?
We’ll require split claims for certain office/hospital visits that span the ICD-10 implementation date. You should submit two bills: one with dates of service through September 30, 2015 with ICD-9 codes, and a second for charges on October 1, 2015 and after with ICD-10 codes. For split claims, our system logic and other processes will appropriately handle the review of both claims together.
For other scenarios and recommendations, review MLN Matters® Number SE1325. It includes institutional services split claims billing instructions for Medicare fee-for-service claims that span the ICD-10 implementation date.
What is Aetna's approach to mapping ICD-9 codes to the ICD-10 codes?
There is no industry standard for mapping. The Centers for Medicare & Medicaid Services (CMS) has provided General Equivalency Mappings (GEMs) as guidance for mapping between ICD-9 and ICD-10 codes. We are using GEMs as a clinical equivalence tool to remediate business rules between ICD-9 and ICD-10 codes.
Will Aetna use a crosswalk for claims processing?
No. As of the compliance date, standard transactions must be submitted with ICD-10 codes. After that date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient/professional) or dates of discharge (inpatient) before the compliance date.
Will Aetna continue to accept ICD-9 codes after the compliance date?
As of the compliance date, we will process claims submitted with ICD-9 codes only for dates of service (outpatient/professional) or dates of discharge (inpatient) before the compliance date.
We will continue to follow communications from the regulatory authorities, and will adapt our approach as permitted.
Will Aetna accept the revised CMS HCFA 1500 paper claim form version 02/12?
Yes. We have been accepting the revised form since January 6, 2014. We will continue to accept and process paper claims submitted on the CMS HCFA 1500 paper claim form version 08/05. The revised HCFA 1500 paper claim form version 02/12 supports various coding requirements and prepares for the conversion to ICD-10 diagnosis coding. Claims for dates of service beginning October 1, 2015 must include ICD-10 diagnosis codes.
What should doctors and facilities do to prepare for the compliance date?
You should contact your billing or software vendors for information on their ICD-10 conversion and testing plans. And, look closely at clinical, financial, billing and coding processes to ensure readiness.
What is PNT Data®?
PNT Data is a simple, secure and Health Insurance Portability and Accountability Act (HIPAA)-compliant exchange that connects providers and payers. Your electronic claims and related transactions are delivered directly via the Internet, with quick validation and confirmation.
PNT Data is free to you for commercial payers and there are no term or volume commitments.
How can I learn more?
We have created several webinars to help you. These give an overview of our testing, including our approach, results and lessons learned.
View ICD-10 testing results webinars
See more questions and answers about ICD-10
Next Step
For more information on ICD-10 implementation
These industry resources may help with your planning and preparation:
Centers for Medicare & Medicaid Services
Workgroup for Electronic Data Interchange
The Physicians Foundation
