Qualifiers
for ICD-10 Diagnosis Codes on Electronic
Claims
As you submit
electronic claims for services, remember
that:
•
Claims with ICD-10 diagnosis
codes must use ICD-10 qualifiers;
all claims for services on or after
October 1, 2015, must use ICD-10
•
Claims with ICD-9 diagnosis
codes must use ICD-9 qualifiers; only
claims for services before October
1, 2015, can use ICD-9
How to
Use ICD-10 Qualifiers
Use ICD-10 qualifiers as follows (FAQ 12889):
•
For ASC X12 837P 5010A1 claims,
the HI01-1 field for the Code List
Qualifier Code must contain the code
“ABK” to indicate the principal ICD-10
diagnosis code being sent. When sending
more than one diagnosis code, use
the qualifier code “ABF” for the Code
List Qualifier Code to indicate up
to 11 additional ICD-10 diagnosis
codes that are sent.
•
For ASC X12 837I 5010A1 claims,
the HI01-1 field for the Principal
Diagnosis Code List Qualifier Code
must contain the code “ABK” to indicate
the principal ICD-10 diagnosis code
being sent. When sending more than
one diagnosis code, use the qualifier
code “ABF” for each Other Diagnosis
Code to indicate up to 24 additional
ICD-10 diagnosis codes that are sent.
•
For NCPDP D.0 claims, in the
492.WE field for the Diagnosis Code
Qualifier, use the code “02” to indicate
an ICD-10 diagnosis code is being
sent.
Keep
Up to Date on ICD-10
Visit the CMS
ICD-10 website and
Roadto10.org for the latest
news and and official resources, including
the
ICD-10 Quick Start
Guide
and
a
contact list for
provider Medicare and Medicaid questions. Sign up for CMS ICD-10 Email
Updates and follow us on Twitter.
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