ICD-10 ‘Flexibilities’ Draw to a Close on October 1

23 Aug 2016 | SOURCE: Healthcare Dive

The CMS has updated a question and answer page to help guide providers on their use of ICD-10 codes, which were finally implemented after much delay and controversy last October.

While the implementation of ICD-10 is approaching its one-year anniversary, one thing will be new this coming October: The end to a concession initially bestowed by CMS on providers due to pressure from the American Medical Association and other industry groups.

The concession had been that for one year following the ICD-10 start date, providers would be granted some “flexibilities” in that they would not be denied Part B claims as long as they used a code from the correct family.

The updated CMS document on ICD-10 codes provides a Q&A for providers on what to expect with the end of the flexibility and confirms there will be no further extension to them beyond the October date.

It stresses that providers should already be coding to the highest level of specificity and that many already are because “many major insurers” did not offer flexibility.

To ensure they are complying, providers should avoid using unspecified ICD-10 codes whenever a more detailed code is possible. “Check the coding on each claim to make sure that it aligns with the clinical documentation,” the page says. It adds that unspecified codes do have their place, however and will still be accepted where appropriate, noting, “You should code each healthcare encounter to the level of certainty known for that encounter.” It suggests, for example, it would be correct to use the appropriate unspecified code for a diagnosis of pneumonia when the specific type has yet to be determined.

The CMS added even with the end to the flexibilities, it is well prepared to process new codes going into effect this October 1. “As demonstrated by the successful ICD-10 transition, CMS is well equipped to handle changes to codes and to processes, and we do not anticipate any delays,” it stated.

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