ICD-10 is coming--will you be ready?

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Fewer than 5 weeks remain until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures. On July 6, 2015 CMS and the AMA announced efforts to help physicians get ready ahead of the October 1 deadline. Guidance released by CMS entails the following:

  • For one year starting October 1, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes provided as long as the physician submitted an ICD-10 from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by WPS, the Kansas Medicare contractor and the Recovery Audit Contractors. However, this guidance does not apply to Local Coverage Determination and National Coverage Determinations when a specific diagnosis code is required.
  • To avoid potential problems with midyear coding changes in CMS quality programs (Physician Quality Reporting System, Value Based Modifier and Meaningful Use) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advance payments if the Medicare contractor, WPS, is unable to process claims within established time limits due to problems with ICD-10

This is not a delay of ICD-10. You will still need to use ICD-10 codes on your claim forms and you must code from the correct family of codes. Medicare will not pay claims for services provided on or after October 1, 2015 with ICD-9 codes. You should continue with your implementation, education, make the necessary system changes and test with payers to make sure your claims process correctly. 

Commercial health plans are reporting that the CMS announcement will have little, if any, impact on how they process claims after October 1, the switch to ICD-10. Practices are encouraged to check health plan websites, including KanCare MCOs for information going forward. Medicaid crossover claims should have little disruption, if any. The following payers have specific ICD-10 information on their websites:

Additional information about the recent CMS guidance as well as other helpful links is listed below or by contacting Ruth Cornwall, KMS Director of Health Care Finance.

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