ICD-10 Starting Oct. 1, But CMS Doesn’t Expect Perfection

Posted on 25 Sep, 2015 |comments_icon 7|By Chris Boucher

Here’s why the first year with new codes might not be so bad.

Well, the ICD-10 implementation date appears like it’s going to stick this time.

According to the latest update from CMS, there won’t be any more delays; ICD-10 will be the new diagnosis coding system beginning Oct. 1, 2015.

Silver lining: While many medical practices probably would’ve welcomed another ICD-10 delay in order to more fully prepare, there have also been positive developments related to how Medicare will police ICD-10 reporting in the first year.

From Oct. 1, 2015 until Oct. 1, 2016, Medicare payers will not deny Part B claims “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right [ICD-10 code] family,” according to the report.

The American Medical Association (AMA) celebrated the Medicare decision, but warned medical offices not to take ICD-10 coding for granted. This ICD-10 leniency is only for a year, after all.

“ICD 10 implementation is set to begin … and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD, in a statement on the AMA Website (www.ama-assn.org/ama/pub/news/news/2015/2015-07-06-cms-ama-help-providers-icd-10.page).

“We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs,” Stack said.

Advice: Use this time to master ICD-10, or at least get better at using the system. You should not take this leniency as a license to be lazy with diagnosis coding next year; strive to choose the proper ICD-10 code every time. But if you don’t code the diagnosis completely right, at least you won’t be looking at a potential denial.

This would also be the time to work with your physicians, making certain they are providing you with the needed additional information to code more specifically and accurately.

Resource: Check out the guidance document for yourself at www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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7 thoughts on “ICD-10 Starting Oct. 1, But CMS Doesn’t Expect Perfection

  1. Great read!a0 This fantastic artlcie clearly identifies and outlines the realities of the upcoming EDI / ICD-10 / HIPAA 4010 to 5010 conversion challenges.a0I work with a U.S. based BPO and strategic services company (headquartered in NY and witha0operations in India).a0 At the moment we are working with over 20 payer/providera0companies, most of which we have already successfully converted them to 5010.a0a0Even with our 10+ years of experience in the healthcare back office space, I’ve seen that with each conversion that new lessons are learned by our team on client specific peculiarities…and our process is now well matured.a0However, as time is growing short we are starting to see more and more companies literally rushing now to ensure that they are ready to start submitting their claims electronically using the X12 Version 5010 and NCPDP Version D.0 standards by the January 1st 2012 deadline. a0We’ll keep checking back to see if you have any updates and suggestions for the industry.a0 Cheers, Angela Carson, Head of Communication at Vee Technologies

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