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ICD-10 Implementation Billing Guide

September 15, 2015

The Department of Health Care Services (DHCS) is providing the ICD-10 Implementation Billing Guide to assist providers in determining how to bill claims that cross over the ICD-10 implementation date on October 1, 2015. It is recommended that the ICD-10 Implementation Billing Guide be used in conjunction with the Medi-Cal provider manuals when submitting a claim.

The guide expands upon the information provided in question 6 of the ICD-10 FAQs on the ICD-10 page of the Medi-Cal website.

Claim Type Claims Date Field To Be Used For Determining ICD Code Version
1 Pharmacy Date of service
2 Long Term Care (LTC) Through date
3 Inpatient Through date
4 Outpatient From date
5 Medical From Date

Dates of Service/Dates of Discharge
Billers must use ICD-9-CM/Volume 3 codes for dates of service/dates of discharge prior to October 1, 2015, and must use ICD-10-CM/PCS codes for dates of service/dates of discharge on or after October 1, 2015. The charts on the ICD-10 Implementation Billing Guide identify for services and provider types billing expectations to ensure compliance with the ICD-10 implementation and mandate rules.

Split Billing
Services and provider types identified as “Split Billing” require that services provided prior to October 1, 2015, be billed with ICD-9-CM/Volume 3 codes on one claim. Services provided on or after October 1, 2015, are billed with ICD-10-CM/PCS codes on a separate claim.

Through Date
Services and provider types identified as “Through Date” require that services with a through date prior to October 1, 2015, be billed with ICD-9-CM/Volume 3 code. Services with a through date on or after October 1, 2015, are billed with ICD-10-CM/PCS codes.