The time is near… CMS ICD 10 Grace Period to End October 1, 2016
By now you should be accustomed to utilizing the ICD 10 diagnosis code standards as dictated by CMS (Centers for Medicare and Medicaid Services). These doctor-patient condition driven codes are required to accompany lab orders in order for insurances to determine coverage and payment for lab services rendered, and now the rules are changing once again to require more specificity.
What has happened in the past year?
CMS promised to not deny claims submitted to Medicare & Medicaid that contained ICD 10 codes in the correct "family of codes."
What will happen October 1, 2016?
CMS will require providers to code to the highest level of specificity to accurate reflect the clinical documentation, as per the coding guidelines. 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 the ICD-10 code as long as there was no evidence of fraud. These ICD-10 medical review flexibilities will end on October 1, 2016.
How do I get ready for the end of flexibilities?
Avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation.
Can I still use codes with just 3 characters?
The short answer is "generally no". Coding should be as specific as the condition allows, and most families of codes are subdivided down to the 4, 5, 6, or 7th characters. For examples, C81 (Hodgkin’s lymphoma) is not valid as the category is subdivided into more specifics. C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes is a valid code.
Are there more changes than just specificity requirements?
Yes! There are 2,305 new ICD 10 codes, 553 revised codes, and 212 deleted codes, so that makes it more important than ever to check your code’s validity before you send a lab order.
Can you tell me what codes to use?
Unfortunately the ICD 10 codes are based on a patient’s diagnosis as determined by a physician, so the laboratory cannot determine a patient’s condition. Writing out a diagnosis such as "fever" is also unacceptable as there are over 50 codes containing "fever" and the lab cannot be responsible for choosing a code for a provider.
Where can I get help?
The Detroit Medical Center University Laboratories offers a web based portal to electronically orders tests,
www.4medica.com, and this site will have all of the updated ICD 10 codes available on 10/1/16. Also, there are websites such as www.cms.gov and www.nuemd.com/icd-10/codes to assist with proper coding. If you have an EMR/EHR, please contact your EMR/EHR representative to ensure your system will have the new coding changes loaded on 10/1/16.
Below are a few resources for assistance.
ICD 10 Look up by NueMD, save your favorite codes, search by specialty, and more.
Official CMS Website
ICD 10 Look Up Tool: Type in a condition and view the list of ICD 10 code options to choose from.
ICD 9 to ICD 10 Conversion: Type in an ICD 9 code to view an equivalent ICD 10 code.
If you need additional assistance, please contact your DMCUL Sales Representative or Technical Representative.