The end to ICD-10 code flexibility: How are you handling it?

It may be hard to believe, but ICD-10 recently celebrated its first birthday. So we thought it only fitting that we post this blog on 10-10.

The change from ICD-9 to ICD-10 meant the addition of thousands of more very specific, and in some cases, very unusual diagnostic codes. Examples include: being pecked by a chicken, bitten by a cow and struck by a macaw. You can read more about that in this Medical Economics article.

The switch to ICD-10 also meant that the Centers for Medicare and Medicaid Services (CMS) was expecting a lot of confusion. That’s why providers were given a year grace period to get it right.

However, effective Oct. 1, that grace period came to an end. That means CMS no longer is accepting unspecified codes on Medicare fee-for-service claims. CMS review contractors will use coding specificity as the reason for an audit for a denial of a reviewed claim. And, the agency says it will “notify providers of coding issues they identify during review and of steps needed to correct those issues.â€

For many providers it’s been business as usual since many commercial health insurers did not offer providers any coding flexibility. Hospitals also were not given a grace period, so essentially it has been a sink or swim scenario for them. But this lack of flexibility could have an impact on smaller providers, especially those who have not yet conducted coding audits.

So, what should you do? If you have not already, it’s time to conduct your own internal audits, particularly of those codes that your practice uses most often. This will assist you in determining if your practice continues to use unspecified codes.

CMS released its own recommendations. Among them: providers should “check the coding on each claim to make sure it aligns with the clinical documentation.â€

CMS also has posted a complete list of the 2016 ICD-10-CM valid codes and code titles.

If you are encountering difficulties with the ICD-10 transition, The Health Law Offices of Anthony C. Vitale can assist you. We can be reached at 305-358-4500 or email us at info@vitalehealthlaw.com.