National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (MM5643)

Provider Types Affected
Physicians, suppliers, and providers billing Medicare contractors (carriers, Medicare administrative Contractors (A/B MAC), durable medical equipment administrative contractors (DMAC), and fiscal intermediaries (FI) including regional home health intermediaries (RHHI))

What Providers Need to Know
CR 5643, from which this article is taken, reminds the Medicare contractors and providers that the annual ICD-9-CM update will be effective for dates of service on and after October 1, 2007 (for institutional providers, effective for discharges on or after October 1, 2007).

You can see the new, revised, and discontinued ICD-9-CM diagnosis codes on the CMS Web site at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07summarytables.asp#TopOfPage , or at the National Center for Health Statistics (NCHS) Web site at http://www.cdc.gov/nchs/icd9.htm in June of each year.

Background
ICD-9-CM codes became mandatory as follows:

• In 1979 for use in reporting provider services on the CMS-1450 Form;
• On April 1, 1989, for use by all physician services submitted on the CMS-1500 Form; and
• On October 1, 2003 for all paper and electronic claims billed to Medicare carriers with the exception of ambulance claims (specialty type 59);

The ICD-9-CM codes are updated annually as stated in the Medicare Claims Processing Manual, Chapter 23 (Fee Schedule Administration and Coding Requirements), Section 10.2 (Relationship of ICD-9-CM Codes and Date of Service).

CMS issued CR 5643 as a reminder that the annual ICD-9-CM coding update will be effective for dates of service on or after October 1, 2007 (for institutional providers, effective for discharges on or after October 1, 2007).

You should remember that an ICD-9-CM code is required for all professional claims (including those from physicians, non-physician practitioners, independent clinical diagnostic laboratories, occupational and physical therapists, independent diagnostic testing facilities, audiologist, ambulatory surgical centers (ASCs)), and for all institutional claims; but is not required for ambulance supplier claims.

Additional Information
You can find the official instruction, CR5643, issued to your Medicare contractor by visiting http://www.cms.hhs.gov/Transmittals/downloads/R1269CP.pdf on the CMS Web site. As mentioned, you can find the new, revised, and discontinued ICD-9-CM diagnosis codes on the CMS Web site at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07summarytables.asp#TopOfPage , or at the National Center for Health Statistics (NCHS) Web site at http://www.cdc.gov/nchs/icd9.htm in June of each year. The annual ICD-9-CM code changes are also included in a CD-ROM, which you can purchase for $25. from the Government Printing Office (GPO), stock number 017-022-01573-1.

To learn more about ICD-9-CM codes, you might want to read Medicare Claims Processing Manual, Chapter 23 (Fee Schedule Administration and Coding Requirements), Section 10.2 (Relationship of ICD-9-CM Codes and Date of Service); or look at the information provided at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/01_overview.asp#TopOfPage on the CMS Web site.

If you have any questions, please contact your carrier, FI, RHHI, A/B MAC, or DMAC at their toll-free number, which may be found at

http://www.cms.hhs. gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5643
Related Change Request (CR) #: 5643
Related CR Release Date: June 15, 2007
Effective Date: October 1, 2007
Related CR Transmittal #: R1269CP
Implementation Date: October 1, 2007