ICD-10: CMS will not be so flexible after Oct. 1
The one-year grace period for ICD-10-coded medical claims will end on Oct. 1, the Centers for Medicare and Medicaid Services said Thursday in a update to its FAQ guidelines for the diagnostic code set.
ICD-10 went live on Oct. 1, 2015, and at the time CMS said it would not deny claims as long as healthcare providers used codes in the correct "family" related to the treatment. However, with the grace period ending, providers will now be held to using the correct degree of specificity in their coded claims.
"ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of theICD-10 code as long as there is no evidence of fraud," CMS said.
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ICD-10, which contains more than 70,000 diagnostic codes, replaced the ICD-9 code set, which relied on just 11,000 codes.
The grace period had only applied to claims submitted to Medicare and Medicaid, and while many commercial insurers offered similar flexibility, the majority did not.
The lead-up to the ICD-10 had many healthcare providers worried that the exponential increase in diagnostic codes would lead to more errors in medical claims, and ultimately denials, due to the new specificity required. But the years of lead-up to the launch due to a handful Congressional delays gave healthcare providers more time to prepare. The years of training, and the extra time to staff-up coding departments paid off. Most studies show the rate of denials had gone practically unchanged since the roll-out.
Though the grace period will end on Oct. 1, CMS said providers will still be allowed to use unspecified codes when they are warranted.
"While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient's health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter. You should code each healthcare encounter to the level of certainty known for that encounter."
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Contact the author: henry.powderly@himssmedia.com
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