Industry News

CMS Issues Claims Processing Guidance for ICD-10.

Lisa Shuman | February 2014

The Centers for Medicare & Medicaid Services (CMS) issued an updated version of the Medicare fee-for-service claims processing guidance for implementation of the International Classification of Diseases, 10th Edition (ICD-10) to reflect the October 1, 2014 implementation date.  Providers must submit claims with the appropriate ICD-10 diagnosis and procedure codes for dates of service on or after October 1, 2014.  CMS provides the following guidance for submitting claims on or after October 1, 2014:

  • Providers and suppliers will continue to be required to report all characters of a valid ICD-10 code on claims. 
  • Providers and suppliers must submit the most specific diagnosis codes based upon the information that is available.
  • Medicare will return institutional claims, as well as professional and supplier claims containing ICD-9 codes for dates of service on or after October 1, 2014, and providers must re-submit the claim with the appropriate ICD-10 code.  
  • Medicare will return claims that are billed with both ICD-9 and ICD-10 procedure codes on the same claim.

CMS has noted potential claims processing issues for institutional, professional, and supplier claims that span the implementation date.  CMS provides a table in the Medicare Learning Network (MLN) Matters article SE1408 that provides guidance to providers for claims that span the periods before and after the ICD-10 implementation date.

Further information on the format of ICD-10 codes is available at:

Providers may contact their Medicare Administrative Contractor at their toll-free number, which is available at:

The MLN Matters article (SE1408) is available at:

Centers for Medicare & Medicaid Services.  “Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Disease, 10th Edition (ICD-10) – A Re-Issue of MM7492.”  MLN Matters Number SE1408.  05 Feb. 2014. 

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.