Kaiser Permanente 2015 ICD-10 implementation FAQs

What are Kaiser Permanente's ICD-10 authorization requirements?
Kaiser Permanente accepts authorizations one month in advance of the service.

Effective Sept. 8, 2015, we accept authorizations for services that begin on or after Oct. 1, 2015 which require ICD-10 coding.

Any authorizations requested with start dates prior to Oct. 1, 2015, should contain ICD-9 coding and will apply to all services within the authorization date span, including services rendered after Oct. 1, 2015.

Crossover Billing: does Kaiser Permanente require split claims for dates of service spanning ICD-9 and ICD-10?
Kaiser Permanente is following the CMS guidelines for crossover dates (spanning Sept and October dates) and which ICD code set should be billed.

For Inpatient services (TOB 11X, 18X, 21X), the ICD set billed is based on the discharge date. If the discharge date is Oct. 1, 2015 or afterward, the services must be billed with the ICD-10 code set.

For outpatient services (TOB 13X) and observation services — CMS requires a split claim requirement for these services. If the patient entered the ER on Sept. 30, 2015 and was discharged on Oct. 1, 2015, the ER charge and any related services performed on Sept. 30 must be billed separately with an ICD-9 code diagnosis. Services performed from 12:01 a.m. to time of discharge on Oct. 1 must be billed with an ICD-10 diagnosis.

CMS guidelines regarding crossover billing:

When will Kaiser Permanente begin accepting ICD-10 code sets on claims?
Per CMS regulations, Kaiser Permanente will be ready to accept ICD-10 code beginning with Oct. 1, 2015 dates of service.

Can my organization submit ICD-10 code sets on claims with dates of service prior to Oct. 1, 2015?
No. Claims with ICD-10 code sets submitted prior to Oct. 1, 2015 cannot be processed and will not be accepted.

Can ICD-9 and ICD-10 codes appear on the same claim after Oct. 1, 2015?
No, both ICD-9 and ICD-10 code sets cannot be submitted on a single claim.

Will the transition to ICD-10 have any impact on timely filing?
The current timely filing deadlines will continue to apply for claims.

Will Kaiser Permanente follow CMS guidelines when diagnosis and procedure laterality does not match (e.g., a patient's condition is bilateral but procedures were only performed on the left or right side but is clinically appropriate?
Kaiser Permanente follows CMS guidelines with our coding software. There is no CPT/HCPCS/Modifier billing changes with the implementation of the more descriptive ICD-10 diagnosis codes.

I had patients referred to me and received an authorization from Kaiser Permanente for the services. I need the patients diagnosis updated to ICD-10 to allow me to bill for dates of service Oct. 1, 2015 and beyond. How can I get an updated diagnosis for billing purposes?
If your licensure allows you to diagnose a patient you should bill the appropriate diagnosis code based on the order from the referring physician and your assessment of the patient, not based on what is on the Kaiser Permanente authorization.

If your licensure does not allow you to diagnose a patient, you will need to contact the referring physician for an updated diagnosis code based on the order.

An exact match to the diagnosis code on the authorization is not required for claims payment.