September 01, 2016
Area(s) of Interest: Practice Management
Physicians are reminded that the Centers for Medicare and Medicaid Services' (CMS) one-year grace period for ICD-10-coded claims is coming to an end on October 1, 2016. As of that date, providers will be required to use the correct degree of specificity in their coded claims.
When ICD-10 went live last year, CMS said it would not deny or audit claims as long as providers used codes in the correct "family" related to the treatment.
According to CMS, the ICD-10 grace period ensured that contractors performing medical reviews would not deny or audit claims solely for the specificity of the ICD-10 code as long as there was no evidence of fraud. As of October 1, 2016, Medicare contractors will begin denying claims not coded to the correct degree of specificity as required under ICD-10.
Physicians should also be aware that there are more than 7,400 changes across the entire ICD-10 code set for this next year, including 2,305 new ICD-10-CM (diagnosis) codes and 3,836 new ICD-10-PCS (procedure) codes.
These figures are dramatically higher than previous years, and physicians should review all sections of the guidelines to fully understand all of the rules and instructions needed to properly code their claims.
Though the ICD-10 grace period will end on October 1, CMS said providers will still be allowed to use "unspecified" codes when they are warranted and there is no other option.
Probably the most important step clinicians can take to prepare for these ICD-10 updates is to document patient diagnoses with precision. In addition, be sure to review the Local Coverage Determination (LCD) and National Coverage Determination (NCD) medical necessity policies for coding changes.
The new ICD-10 codes become effective on October 1, 2016.