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Provider Manual

ICD-10 Implementation

Last Updated on January 24, 2019

As communicated, effective October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures have been replaced by ICD-10 codes. If any issues are identified with the new coding we will use this website location to provide updates. 

October 9, 2015 ICD-10 Update

Important information based on claim rejections we are seeing

Coding Claims: When to Use ICD-10 versus ICD-9

Use of ICD-10 versus ICD-9 on claims is based on dates of service—not on dates that claims are submitted.

  • For dates of service before October 1, 2015, use ICD-9 codes.
  • For dates of service on or after October 1, 2015, use ICD-10 codes.

For example, if you submit a claim for services provided on September 30, 2015, use ICD-9, even if you are submitting the claim in October 2015 or beyond.

For hospital inpatient claims, use date of discharge rather than date of service to determine whether to code in ICD-10 or ICD-9.

When billing electronically, send a “BK” indicator for ICD9 codes and an “ABK” indicator for ICD10 codes.

How do I indicate if I am using ICD-9 or ICD-10 on the paper claim forms (CMS-1500 and UB-04)?

Field 21 of the CMS1500 form gives providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes on the form, using a single-digit numeric value in the top right of the field. The UB-04 form includes a space for the version indicator in field 66. For both forms, the valid values for these qualifiers are “0” and “9.” An indicator of "9" means that all diagnosis codes that follow are in ICD-9 and an indicator of "0" means that all diagnosis codes that follow are in ICD-10. There is only one ICD indicator per form, and providers cannot mix ICD-9 and ICD-10 codes on the same claim form.

ICD-10 qualifier Documentation

Electronic claims

Code Qualifiers: In the electronic claim, the ICD version indicator is in the HI – Health Care Diagnosis Code segment. Ø Professional Claim (837P) ICD Code Set Qualifiers: HI – Health Care Diagnosis Code segment / loop 2300 ABK = ICD-10-CM – Principal Diagnosis BK = ICD-9-CM – Principal Diagnosis ABF = ICD-10-CM – Diagnosis BF = ICD-9-CM – Diagnosis

Paper claims

Field 21 of the CMS1500 form gives providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes on the form, using a single-digit numeric value in the top right of the field. The UB-04 form includes a space for the version indicator in field 66. For both forms, the valid values for these qualifiers are “0” and “9.” An indicator of "9" means that all diagnosis codes that follow are in ICD-9 and an indicator of "0" means that all diagnosis codes that follow are in ICD-10. There is only one ICD indicator per form, and providers cannot mix ICD-9 and ICD-10 codes on the same claim form.

We are always available to help with information and answers to your ICD-10 questions. Contact our Provider Relations and Contracting Department at 1-800-548-1224 or by email at shpprd@securityhealth.org.

Common questions about ICD-10

Click here for a list of common questions to help you learn how the transition to ICD-10 will affect your organization and what you will need to do to comply with the new requirements.