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ICD-10 Implementation Begins October 1st

An important message from NCPA:

ICD-10 Implementation Begins October 1st:  Oct. 1 is the compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the Department of Health and Human Services has announced. ICD-10 is the10th revision of the International Classification of Diseases, which provides the medical data code sets for coding diagnoses (ICD-10-CM). Below are some key take-aways for pharmacies to be aware of to ensure compliance:

  • Diagnosis codes in the current ICD version are always required on prescriptions for Medicare Part B claims for proper adjudication. Some prior authorization claims will also require submission of a diagnosis code, along with claims for Workers Compensation.
  • Beginning Oct. 1, ICD-10 will be the required version for documenting diagnosis codes—claims that are submitted in ICD-9 or other prior versions will be rejected.
  • For electronic prescriptions—if the resulting claim requires a diagnosis code and would have been required on a paper prescriptions, an ICD-10-CM code would need to be submitted on the electronic prescription as well.
  • Pharmacies are advised to work with their trading partners, system vendors, and any other billing intermediaries to prepare for the change to ICD-10. Resources such as crosswalks and mapping may assist entities in converting from ICD-9 to ICD-10 when there is an exact match. However, in instances where there is not a corresponding code, pharmacies are strongly encouraged to proactively reach out to physicians to obtain the new ICD-10 codes to allow pharmacy systems to store these codes that will be needed for claims submission by the compliance date.
  • To better prepare for these changes, it is also recommended that pharmacies generate reports on patients with active Medicare Part B claims to anticipate which prescriptions will require the updated diagnosis codes.
  • Patients should be alerted that there may be a delay in care as pharmacies need to contact their prescriber for updated information before they are able to fill certain prescriptions, due to a change in Medicare rules.

For more information, please visit the Provider Resource page on ICD-10 provided by the Centers for Medicare & Medicaid Services or review this document from NCPDP with a 'Frequently Asked Questions' section for pharmacies.

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