Electronic Health Records

CMS 1500 Medicare claim form gets an ICD-10 update

For physicians who submit Medicare claims on paper, now is the time to start using up your reserve boxes of 1500 claims forms.  The paperwork has received its ICD-10 facelift, and the current version will no longer be accepted by CMS on April 1, 2014.  While there will be a transition period during which both versions of 1500 form will be accepted, providers will get an advanced screening of some of the documentation and administration challenges they will face with the new code set, slated to take effect on October 1, 2014.

The National Uniform Claim Committee (NUCC) provides periodic updates to the commonly used form based on industry needs, and recently approved the newest iteration, called “version 02/12” earlier this summer.  The paper form is provided for physicians who meet exceptions to the electronic reporting rule that the majority of providers must follow under the Administrative Simplification Compliance Act (ASCA).  The new form includes a mechanism for indicating whether an ICD-9 or ICD-10 code is being used, and expands the number of possible diagnosis codes from four to 12.

Despite the capability to distinguish which code is being used for a claim, CMS has not changed the current rule stating that no ICD-10 codes will be accepted for services performed before October 1, 2014, and no ICD-9 codes will be accepted for services performed after that date.  The option may be necessary for services that span that time period, however, such as for patients hospitalized for several days during the switch.

CMS also released a tentative outline for phasing in the new documentation.  The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted.  NUCC notes that the timeline may change, and urges providers to check with their payers and clearinghouses to determine when they will begin to accept the new 1500 form.  NUCC has also provided an instruction manual for using the new 02/12 form, and asks providers to keep an eye out for any CMS updates to the process.

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