The CMS has issued an 11-page list of questions and answers to better guide providers in using ICD-10 codes.
The federally mandated conversion to the more numerous and granular ICD-10 family of diagnostic and procedural codes began Oct. 1, 2015, but not before the American Medical Association and other groups extracted concessions (PDF) from the CMS.
The federal agency in charge of Medicare agreed that for one year after the Oct. 1 start date it would grant providers certain “flexibilities”—that is, Medicare will not deny physicians or other practitioners Part B claims “based solely on the specificity of the ICD-10 diagnosis code” as long as the provider used a valid code “from the right family.”
Many of the questions and answers in the new CMS document address these exceptions and what happens when they end on Oct. 1 this year.
For example, Question 26 asks, “How do I get ready for the end of flexibilities?” The CMS advises providers to avoid using so-called “unspecified” codes when documentation of the patient encounter supports a more detailed ICD-10 code. “Check the coding on each claim to make sure that it aligns with the clinical documentation."
In response to another question, the CMS said it is “well equipped” to handle changes in coding requirements once the period of flexibility expires. “We do not anticipate any delays,” the agency said. The CMS also has a state-by-state list (PDF) of ICD-10 resources and contact information, including phone numbers of Medicare administrative contractors and state Medicaid offices.