CMS Offers Guidance on ICD-10, Dual Coding and Dual Processing

In a recent news update, the Centers for Medicare & Medicaid Services provided guidance concerning dual coding and dual processing.

As CMS notes, discussions of ICD-9 and ICD-10 often include mention of these terms. Different people use these terms to mean different things, but in general, dual coding or processing refers to the use of ICD-9 and ICD-10 codes at the same time.

When can you expect to use dual coding and processing and when can’t you?

1. Testing to Prepare for ICD-10
Dual coding and dual processing can be useful tools to prepare for ICD-10 by testing whether you are able to prepare, send, receive and process transactions with ICD-10. However, CMS says ICD-10 can be used for testing purposes only before the compliance date; providers and payers cannot use ICD-10 in "live" transactions for dates of service before the ICD-10 compliance date (October 1, 2015).

2. Dual Coding and Dual Processing After the Compliance Date

Following the ICD-10 compliance date, providers and payers must use:

  • ICD-9 in transactions for services provided before the compliance date
  • ICD-10 in transactions for services provided on or after the compliance date

While providers and payers must be able to use both ICD-9 and ICD-10 codes after the compliance date to accommodate backlogs in claims and other transactions, CMS notes they will not be able to choose to use either ICD-9 or ICD-10 for a given transaction. The date of service determines whether ICD-9 or ICD-10 is to be used.

The transition from ICD-9 to ICD-10 could significantly disrupt payments to practices due to the complexity of the new code set. To reduce the negative financial effects of the transition, considering outsourcing your billing to a veteran medical billing service provider such as PGM Billing. With more than 30 years of coding and billing experience, PGM can help ensure you collect what you deserve while eliminating the costs associated with paying for a medical biller's salary, benefits, bonuses, training and the technology needed to do the job.


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