Hayes' Healthcare Blog

Prepare for New CMS 1500 Form to be Implemented Q1 2014

Posted by Robyn O'Connell on December 9, 2013 at 7:30 AM

Robyn O'Connell HayesIn preparation for ICD-10, the National Uniform Claim Committee (NUCC) has approved an updated 1500 form that will allow up to 12 diagnoses codes as opposed to the previous version’s four (4). This change has been needed since electronic claims have allowed more than the four diagnoses on the current 1500 Form for years.

A new field has been added in Box 21 to indicate whether the diagnoses codes sent will be ICD-10 or ICD-9. This will be the biggest challenge, because vendors vary regarding how the codes are reported. Also, after 10/1/2014, you may have payers that will not be prepared to accept ICD-10. Payers that are not prepared to accept claims with ICD-10 codes will need claims to be submitted with ICD-9 for a period of time, especially in the cases of Workmen’s Compensation and Liability Insurers (who have been given an exemption on ICD-10 implementation by CMS). Based on the experience of the upgrade to version 5010 of the electronic claims, it will not be surprising if many payers will not be prepared. It is important that you monitor the progress of your payers and identify when they will be prepared to accept ICD-10-coded claims.

Diagnosis pointers have also been changed to an alpha structure. ‘1’ is now ‘A’, and ‘2’ is now ‘B’. This change was necessary to allow the 10TH-12TH diagnoses pointers to fit in the 24 E box, which only allows four characters. I applaud NUCC for not making big structural changes to the form that would require major changes to paper claim setup.

There are a few changes in addition to the expansion of the diagnoses codes, but the changes are not overwhelming. It is recommended that you order the new forms now if you have not already since demand may cause a backlog of orders, which we have seen with some printing companies. The new forms will be accepted by CMS as of 1/6/2014 with dual use allowed through March 31st.  More information is available at http://www.nucc.org/.



Topics: icd10 1500 form, NUCC report, 1500 form icd-10

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