Click here for Examples of Header and Unspecified Codes.
DMBA follows the standards of the industry, including the ICD-10 standards published by Utah Health Information Network (UHIN).
You may view this and other valuable information about ICD-10 on their website at
Please consider the following points, as you work towards transitioning to ICD-10:
- DMBA will begin accepting ICD-10 codes for dates of service beginning October 1, 2015. Any ICD-9 codes received
for dates of service after that date are denied.
- DMBA will follow the Centers for Diseases Control (CDC) guidelines regarding the processing of header codes and
codes valid for HIPAA transactions. Header codes are denied with a request for more specificity.
- Only codes that are valid for HIPAA transactions and meet the required level of specificity will be paid.
Therefore, it’s imperative the physician’s clinical documentation is adequately detailed, to ensure the appropriate
ICD-10 code is billed. Facilities should submit ICD-10 codes that are appropriate for the discharge date.
- An “unspecified” code may be valid for billing HIPAA transactions. However, it does not meet the appropriate level of specificity
for supporting medical necessity. DMBA tracks providers who routinely bill unspecified codes, which could result in rejected claims
or claim suspension requesting more information.
- It’s important to note, there are some duplicate codes between ICD-9 an ICD-10 that have significantly different meanings. When one of these
duplicate codes is submitted, DMBA will assume the code is an ICD-9 code for dates of service through September 30, 2015, and an
ICD-10 code for dates of service for dates of service beginning October 1, 2015.
- The latest ICD-10 news and resources may be found at http://cms.gov/Medicare/Coding/ICD10/index.html,
including the General Equivalence Mappings (GEM) tool, which was created by the Centers for Medicare & Medicaid Services (CMS) and the
Centers for Disease Control and Prevention (CDC) to assist with the conversion of ICD-9 codes to ICD-10 codes and vice versa.