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The ICD-10 regulations became effective on October 1, 2015. You need to be aware of these regulations and how they impact claims submissions and electronic transactions with payers.

ICD-10 Overview

Centers for Medicare & Medicaid Services (CMS) Federal rule requires that ICD-10 diagnosis & procedure codes replace ICD-9 codes for services starting October 1, 2015. Highlights of the ICD-10 regulation include:

  • Number of diagnosis codes increases from 13,000 to 68,000; size increases to up to 7 alpha numeric characters. (ICD-10 diagnosis codes apply to professional & institutional claims.)
  • Number of procedure codes increases from 3,000 to 87,000; size increases to 7 alpha numeric characters. (ICD-10 procedure codes used for institutional claims only.)
  • HCPCS/CPT procedure codes are not impacted.

We will continue to provide updates as needed via the Provider Bulletin newsletter and our Provider Center website.

CMS ICD-10 Resources

* BCNEPA will be following these guidelines with one exception: anywhere that it states a claim will be “returned as unprocessable” does not apply to BCNEPA and rather, the claim will be rejected.

PA Blues ICD-10 Provider Education Collaborative Monthly Presentations

Next "What's Up Wednesday" Call
Date: September 16, 2015
Time: 2pm – 3pm
Phone Number: 1-800-882-3610
Pass Code: 5411307

What's Up Wednesday Archive

ICD-10 End-to-End Testing

Provider Bulletin ICD-10 Articles