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Major Announcement on ICD-10 from AMA and CMS

By: | Tags: , , , , , | Comments: 0 | July 20th, 2015

On July 6, 2015 the American Medical Association and The Center for Medicare & Medicaid Services (CMS) announced a new initiative to “help physicians get ready ahead of the October 1 deadline for conversion from the ICD-9 to ICD-10 codes.” In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.”

The key part of the announcement is though is that the AMA and CMS will continue to strive for full ICD-10 conversion, CMS is showing more flexibility:

“For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review 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. [our highlight]. 

“However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.” 

The AMA communique went on to say, “CMS had set up a “free help that includes the “ Road to 10 ” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips. “

This problem may be better however, it still leaves unresolved issues. Some members of the U.S. Congress have publicly recommended that a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that “a valid ICD-10 code will be required on all claims starting Oct. 1, 2015.”

I am on the side of doctors and Congress; there is ZERO reasons why CMS cannot accept either codes, or as it may be referred to as “dual coding” for one to two years. Based on my unscientific survey, less than 50% of small practices are ready today, and with all the other changes, this could be a huge financial blow to small providers.

– Noel J. Guillama, President,c9801931

[1] The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures.

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