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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 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 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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