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Back  RFI # 882: ICD9 and ICD10

Formal vs. Informal Help Informal Formal

Submitter

Ginger Cox

Description

When there is a crossover in service dates on 837 Professional claim, can we submit both ICD-9 codes for services prior to 10/1/2013 and ICD-10 codes for services on or after 10/1/2013?

Submitter Assigned Keywords

ICD9 1CD10 Code Set

Response

This issue is addressed explicitly in the 5010 837 Professional implementation guide. The 2300 Loop HI segment for Health Care Diagnosis Code supports separate code qualifiers for each HI segment composite element. It is possible to report a mixture of ICD-9-CM and ICD-10-CM codes within the same HI segment. Individual 2400 loops can then point to only the appropriate diagnoses for each specific service using the SV107 composite. In this way, the services performed prior to October 1, 2013 can point to ICD-9 codes and those on or after 10/1/2013 can point to ICD-10 codes

Recommendation

X12 is limited to addressing only the technical response to this HIR. There may be policy impacts related to this issue that are outside the purview of X12. While it is technically possible to report a mix of ICD-9 and ICD-10, Submitters should be aware that some payer systems may not be able to process both ICD-9 and ICD-10 codes on the same claim successfully. Receivers may have established business rules that address this issue as well.
Submission 10/8/2009
Status Date 2/12/2010
Status F - Final
Primary References
Document 005010X222
Section2.4.837
Set ID837P
Table2
Loop2300
Segment Position2310
Segment IDHI
Element PositionH1
Component Position01
Industry NameHealth Care Diagnosis Code
External Code ListCode Sources 131 and 897
Code ValueDE # 1270