Question

Write a paragraph

2. Important dates and events in the creation and revision of the form.

• What version of the CMS-1500 became effective 1 October 2014?
• What were the major revisions on the CMS-1500 (08-05) version?

Answer 1

CMS-1500 is a standard form used for the billing of medical claims (for insurance purposes) by physicians and suppliers.

Prior to April 2014, the 08/05 version was in operation. With the tenth revision of the International Classification of diseases (Clinical modification) - ICD-10-CM, and to promote electronic reporting of claims, a revised version, viz. 02/12, was approved in Jan 2014, and scheduled for use starting April 2014 - which later got postponed to October 2014.

The main difference between the two versions is that 02/12 has more fields to report diagnoses codes (it can list up to 12 diagnoses codes overall). These fields are labelled from A-L, rather than 1-4, and can have codes up to the length of seven characters each. There are instructions to relate these fields (A-L) to specific service lines in the Diagnosis pointer column. Also, there's the addition of an ICD indicator field to accommodate the reporting of both ICD-9-CM and ICD-10-CM codes. New qualifier fields have been added alongside Items 14, 15 and 17 - that record additional useful information. For example, the qualifier column next to Item 15 (which records dates regarding a patient's treatment or onset of some medical condition) records information on previous treatments, earlier prescriptions, recent visits, last X-ray etc.