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ICD-10 Tips

  1. For problems related to ICD10, start with your Medicare Administrative Contractor or contact the ICD-10 Coodination Center. For further assistance, contact the ICD-10 Ombudsman.
  2. For coding issues with Medicare (Part A or B, DME, or home health/hospice) and Medicaid, refer to this contact list for all US states and territories.
  3. Make sure diagnosis is consistent with the procedure (age, gender, provider type, and so on).
  4. Is the code valid? For Medicare FFS, it must at least be the right "family" but for private payers and Medicaid, it needs to be as specific as possible. Use a book or electronic tool to confirm valid vs. invalid codes. CMS has a free look-up tool and ACP has a downloadable "Commonly Used ICD-10-CM Codes" list.
  5. Keep medical necessity in mind. Does the code used support the CPT code? While this is nothing new, it is something to be hyper-vigilant about in the beginning.
  6. Be aware of referrals and authorizations that used ICD9 codes. Map back to ICD9 if necessary. Double check date of service and use correct code set.
  7. Track denials carefully - learn from mistakes and resubmit claims as soon as possible. Follow-up with payer as needed.
  8. For problems with private payers, check the payer's website for information about ICD-10 implementation and a method of contact for issues. For UnitedHealth Group, physicians can use the following email address ICD10questions@uhc.com. For Humana, physicians can use the following email address ICD10Inquiries@humana.com. For Anthem, physicians should contact the Provider Service Call Center for the locality and line of business involved (telephone numbers can be found on Anthem.com).

More ICD-10 resources