Prepare to code more specific ICD-10 codes Oct. 1 as flexibilities end

by: Laura Evans Aug 18, 2016

CMS confirmed Aug. 18 that it will end its ICD-10-CM coding flexibilities for Medicare Part B claims on Oct. 1, with no extension and no phase-in period for reporting the more specific codes.

“Providers should already be coding to the highest level of specificity,” the agency stated in its update to a Q&A document on the flexibilities.

The flexibilities gave you a certain amount of latitude to report less-specific ICD-10 diagnosis codes during the first year of implementation. Their purpose, CMS now states, was to prevent medical review contractors from denying claims based “solely for the specificity of the ICD-10 code as long as there is no evidence of fraud.”

Starting Oct. 1, however, “all CMS review contractors are able to use coding specificity as the reason for an audit for a denial of a reviewed claim to the same extent that they did prior to Oct. 1, 2015,” the agency now states.

That doesn’t mean unspecified codes will no longer be allowed on your Part B Medicare claims, though.

“In ICD-10-CM, unspecified codes have acceptable, even necessary uses,” CMS points out in the document. “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 health care encounter to the level of certainty known for that encounter,” the agency instructs.

View the updated Q&A document here: https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf.

For background on the flexibilities, check out Part B News’ coverage. For more on how to track the use of unspecified codes and improve accuracy, check out this Part B News story.

Blog Tags: ICD-10

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