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New Approach By CMS

The Centers for Medicare and Medicaid Services released a statement recently, which stated that the one-year grace period for ICD-10-coded medical claims would conclude by October 1, 2016.

The ICD-10 program was initiated on October 1, 2015 and CMS ensured that claims will not be denied if healthcare providers use codes in the correct “family” related to the treatment. Healthcare providers will now have to use the correct degree of specificity in coded claims as the grace period is going to end in a month.

CMS said, “ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of theICD-10 code as long as there is no evidence of fraud.”

The ICD-10 code set is updated by CMS to incorporate 5,500 additional codes related to additional body parts, devices, addition of bifurcation as a qualifier, congenital cardiac procedures, and placement of intravascular neurostimulators. Overall, ICD-10 coding system has over 70,000 diagnostic codes, whereas the predecessor system, ICD-9, relied on approximately 11,000 codes only.

It is to be noted that the grace period was only applicable to Medicare and Medicaid claims. Even though a large percentage of commercial insurers refused to offer such flexibility, some insurers were ready to provide the offer.

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Amendments to ICD 9

Many of the healthcare providers were concerned that the updated ICD-10 code set might result in ultimate denials and more errors in medical claims. However, a few Congressional delays offered healthcare providers enough time to eliminate the risks. In fact, the effort and training put up by healthcare providers in the extra time has successfully eliminated all the potential risks. Moreover, many researches indicate that the rate of denial remain unaltered since the update of ICD-10.

CMS has also permitted healthcare providers to use unspecific codes, when they are required. “While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter. You should code each healthcare encounter to the level of certainty known for that encounter,” the agency said.

CMS also stated that major insures will not be affected by police ending as “many major insurers did not choose to offer coding flexibility; so many providers are already using specific codes.”