Providers Have Flexibility in First Year of ICD-10 Health care providers must switch to a new diagnosis coding system on Oct. 1, but have a 12-month grace period to get the change right. A joint statement from the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association on the transition from the ninth to the ... News in Brief
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News in Brief  |   September 01, 2015
Providers Have Flexibility in First Year of ICD-10
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News in Brief   |   September 01, 2015
Providers Have Flexibility in First Year of ICD-10
The ASHA Leader, September 2015, Vol. 20, 16. doi:10.1044/leader.NIB10.20092015.16
The ASHA Leader, September 2015, Vol. 20, 16. doi:10.1044/leader.NIB10.20092015.16
Health care providers must switch to a new diagnosis coding system on Oct. 1, but have a 12-month grace period to get the change right.
A joint statement from the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association on the transition from the ninth to the 10th revision of the International Classification of Diseases (ICD-10) allows for “flexibility in the claims auditing and quality reporting process.”
Through Sept. 30, 2016, Medicare contractors won’t 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 family.”
Claim reviews or denials may still occur for other reasons, including using a code that is not consistent with a Medicare policy, such as a local or national coverage determination.
According to CMS, a “family” is a group of codes within the same three-character category. A code is considered “valid” if it is recorded at the highest available level of specificity—that is, the code contains the highest number of digits available in that family.
For example, a claim for a patient with oropharyngeal dysphagia (R13.12) has the incorrect ICD-10 code R13.19 (other dysphagia). However, the claim may be acceptable because the code has the correct number of digits and is in the R13 family of dysphagia codes.
It is unclear if private insurance, Medicare Advantage or Medicaid will adopt this policy. Audiologists and SLPs should continue to assign the most specific and accurate code(s) possible, regardless of payer.
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September 2015
Volume 20, Issue 9