ICD-10 October Compliance Date Approaches

PROVIDER ALERT

On Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) transitions from International Classification of Diseases, 9th Edition (ICD-9) to International Classification of Diseases, 10th Edition (ICD-10) as the medical code set for medical diagnosis and inpatient hospital procedures. Providers not using valid ICD-10 codes beginning Oct. 1, 2015, will be unable to successfully bill for services.

Effective Oct. 1, 2015, claims submitted to SCDHHS must include ICD-10 diagnosis or inpatient procedure codes for any claim with a date of service or date of discharge on or after Oct. 1, 2015. A claim with a date of service or date of discharge before Oct. 1, 2015, must contain ICD-9 codes. A claim submitted with ICD-9 codes after Oct. 1, 2015, must have a service date before Oct. 1, 2015.

  • Claims submitted with ICD-9 codes that contain a date of service or date of discharge of Oct. 1, 2015, or after will be rejected.
  • Claims submitted with ICD-10 codes that contain a date of service or date of discharge of Sept. 30, 2015, or before will be rejected.
  • Claims submitted with both ICD-9 and ICD-10 codes will be rejected. Two separate claims with the appropriate ICD-9 or ICD-10 codes must be submitted based on the date of service or date of discharge.

For more information regarding the U.S. Department of Health and Human Services (HHS)-published ICD-10 compliance date, including commonly asked questions and resources, please visit scdhhs.gov/icd10 or roadto10.org. You may also contact the Provider Service Center at (888) 289-0709 and reference issue code PS286.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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