ICD-10 implementation brings with it a host of concerns and relative anxiety to medical practices of all types. Until offices have begun to use the new guidelines, and fully assimilated their reporting and claims processes, there will be a period of uncertainty.
CMS processing systems will not accept ICD-9 codes for services occurring after September 30, 2015, nor will they accept claims that contain both ICD-9 and ICD-10 codes. However, CMS notes the need for a period of adjustment, and has agreed to not deny claims that contain an erroneous diagnosis code as long as the claim is coded for the correct broad family, or category, of codes through October 1, 2016.
The ICD-10 code structure includes a three-digit category code (Family of codes), the diagnosis, or etiology code, and an extension. The category code must be correctly identified for a claim to be paid under this agreement. This will give private practitioners and their offices time to adjust to the new ICD-10 codes.
A note of caution is offered here to beware of any inclination to be lax in terms of coding and billing. Bad habits easily form through complacency, and not holding coding specialists accountable for correctly coding for the appropriate ICD-10 codes can create a multitude of problems later. Every effort should be made to correctly code the first time to ensure that the practice will continue to be in compliance.
CMS will also not penalize physicians with regard to “the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.”
CMS has also disclosed the addition of an ICD-10 Ombudsman to the online resources available to physicians and the medical community at large. The Ombudsman’s job is to offer guidance and information, help medical practitioners transition, and achieve continuity through the process. Dr. William Rogers is the ICD-10 Ombudsman. Inquiries can be submitted to him by email to ICD10_Ombudsman@cms.hhs.gov.