Be in the Know about ICD-10 Codes

When the final announcement was made that ICD-10 codes would be implemented on 10/1/2015, there was quite a bit of anxiety among the healthcare industry in the U.S. But, it is now 9/30/16, and for the most part the industry has not suffered a loss due to the code set change. That fact is largely due to the ‘grace period’ allowed by CMS during the transition.

In July 2015, in response to requests from the provider community when asking for assistance in making the move the ICD-10, CMS released the statement, “For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.” Roughly translated, this means that as long as your assigned ‘unspecified code’ was within the correct ‘family’ of codes in correlation to the patient’s medical record, the claim would not be denied solely because of the diagnosis code.

CMS released a statement last week saying that it “will not extend ICD-10 flexibilities beyond October 1, 2016. There will be no additional flexibility guidance.” They also stated, “Medicare will not phase in the requirement to code to the highest level of specificity. Providers should already be coding to the highest level of specificity.”

To further complicate the process, earlier this year, the Centers for Disease Control and Prevention released roughly 1,900 diagnosis codes to be added to the ICD-10 code set for use in 2017. Also, approximately 3,600 new ICD-10 inpatient procedure codes were added in March. The unusually large number of new codes is credited to the partial freeze on updates during the transition from ICD-9 to ICD-10.

Finally, CMS states that providers can prepare themselves for the end of the ‘grace period’ by, “avoiding unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation”.


For more information, check out this ICD-10 Website


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