Alert - 1-Year Grace Period for ICD-10 Coding Ends on October 1

Alert - 1-Year Grace Period for ICD-10 Coding Ends on October 1

As the one-year grace period for ICD-10 coding draws to a close, physicians need to start coding with the highest level of specificity to get paid.

Starting October 1, 2015, health care providers across the U.S. were under orders to switch to ICD-10 coding. With more than 100,000 new codes, the new coding system allows doctors to make a more detailed assessment of patients than ever before. The new codes run to a maximum of seven characters compared with five for their predecessors so that physicians can provide a comprehensive description of illnesses and injuries. October 1, 2016 marks the end of the one-year grace period for ICD-10 coding.

Compared to the ICD-9 codes, the ICD-10 codes are not only more numerous but longer and more precise. The Centers for Medicare and Medicaid (CMS) and the and the American Medical Association granted the one-year grace period so that claims would not be rejected for reimbursement simply because the ICD-10 code submitted lacked specificity – provided there is no evidence of fraud. The grace period was meant to help ease the transition from ICD-9 to ICD-10 for physician practices. The flexibilities offered included: 

The code submitted will be accepted as long it is in the correct ICD-10 family.

“Correct family” refers to the first three characters of an ICD-10 code. According to

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CMS, codes within a three-character category are clinically related and provide differences in capturing specific information on the type of condition.

For instance, take a diagnosis indicating G43.711 (Chronic migraine without aura, intractable, with status migrainosus). CMS specified that, “Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not trigger an audit for 12 months after ICD-10 implementation on October 1, 2015 since they are all in the same G43.family of codes.

In other words, physicians must report a valid code and not a category number, though in many cases, the code will require more than 3 characters in order to be valid.

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There will be no penalty for submission of less than perfect ICD-10 codes to Medicare’s Physician Quality Reporting System.

Come October 1, 2016 and CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when the medical record warrants a specific one. Regardless of their specialty, physicians will need to fine-tune their diagnoses and submit accurate ICD-10 codes with the highest level of specificity and detail supported by the encounter and the medical documentation to prevent denials.

Physicians need to gear up to face end of ICD-10 flexibilities and get proper reimbursement for their work. Regardless of their specialty, the need for greater specificity will make the new and complex code set more difficult to manage. Practices that submit unspecified ICD10 codes after October 1, 2016 are at a risk of increase in claims rejections. An increased incidence of rejections increase will trigger audits and payer requirements for medical records and clinical documentation.

Established medical billing and coding companies are well-positioned to help physicians sail smoothly through the end of the ICD-10 grace period and beyond. By outsourcing medical billing to a company with an expert billing and coding team, physicians can avoid submitting unspecified ICD-10 codes whenever the medical record supports a more detailed code. Reliable service providers have stringent quality control measures in place to ensure that all claims are thoroughly checked to align with coding guidelines and clinical documentation before they are submitted for payment.

www.outsourcestrategies.com

Phone: 1-800-670-2809