ICD-10 Grace Period Announced for Medicare Claims

    The October 1, 2015 deadline is still in effect for the transition to ICD-10. However, CMS acknowledges that the transition can impact payment processing and announced there will be some flexibility in claims auditing and quality reporting processes. Note: This is a CMS policy only. Private payers have made no such announcement.

    ACOG strongly supported the AMA’s request for a grace period to allow physicians time to gain experience using the ICD-10 code set and to avoid financial disruption in their practices.

    CMS announced that:

    ‘Specific’ vs ‘Family’ of ICD-10 codes for claims and quality reporting.

    • For one year, claims will not be denied or audited based on the specificity of the code as long as a code from the appropriate family of ICD-10 codes is submitted.
    • The 2015 Quality reporting year for PQRS, VBM, or Meaningful Use will not be subject to penalties for CMS difficulties in calculating quality scores as long as the ICD-10 code submitted is in the appropriate family.

    Advanced Payments

    • Can be authorized if Part B Medicare contractors are unable to process claims within established time limits due to administrative problems related to ICD-10 implementation.

    Communications Help Center

    • Includes an ICD-10 Ombudsman to triage physician problems during the transition to ICD-10.

    CMS ICD-10 Updates

    Countdown to ICD-10 with CMS's New Video

    To respond to myths and common misperceptions about ICD-10, the Centers for Medicare & Medicaid Services (CMS) has developed a new video.  The animated short feautres a countdown with 10 facts about the new code set and transition.

    Watch the video to learn the facts about ICD-10.

    Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities

    On July 6, 2015, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) released a joint statement about their efforts to help the provider community get ready for ICD-10.  This statement included guidance from CMS that allows for flexibility in the claims auditing and quality reporting processes.

    In response to questions from the health care community, CMS has released "Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities," which provides answers to the most commonly asked questions.


    CMS ICD-10 Resources

    As with ICD-9, ample resources are available to assist you with coding and clinical documentation for ICD-10.

    Official government coding guidlines cover:

    CMS offers documentation and coding basics for clinicians in the Road to 10 Clinical Concepts Series with tailored guidance for:

    Free lists of codes and ICD-9/ICD10 mapping are also available from CMS

    ICD-10 Basics
    These resources will introduce you to ICD-10, explain why it's necessary, and give you the information you'll need to get started on your transition.

    Checklists, Timelines, and Implementation Guides
    Checklists and timelines provide an at-a-glance view of what you need to do to get ICD-10 ready. The ICD-10 implementation guides provide detailed information about the ICD-10 transition. Please note that the dates and milestones in these materials are recommendations only; you can adapt them to your needs for meeting the October 1, 2015, deadline.

    Implementation Planning
    Get step-by-step information to help you plan for the transition.

    Communicating About ICD-10
    Communication between health care providers, software vendors, clearinghouses, and billing services is an important part of the transition process. Learn how to get the conversation started.

    Medscape Education: CME Credits Available
    Continuing medical education (CME) credits are available to physicians who complete the learning modules for small-medium practices or large practices, but anyone can take them and receive a certificate of completion.

    Keep Up to Date on ICD-10
    Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2015 deadline.

    Frequently Asked Questions 

    What is ICD-10?
    The World Health Organization (WHO) maintains the International Classification of Diseases (ICD) which is the standard diagnostic tool for epidemiology, health management, and clinical purposes. ICD is used to classify morbidity and mortality for tracking vital statistics and health insurance reimbursement across the world. ICD nomenclature provides standardization of disease classification that is used worldwide. The ICD system has been in evolution for over 150 years. The ICD codes are revised and updated by WHO once every ten years to meet the advances in medical science and assure comparability of health statistics internationally. ICD-10 is the most recent standardized set of codes, and was endorsed by the Forty-third World  Health Assembly in May 1990 and came into use by WHO Member States since 1994. Currently, ICD10 is considered the world standard for health and disease classification. More information on the history of ICD 10 and up-to-date implementation information is available on the WHO website: http://www.who.int/classifications/icd/en/

    Why is ICD-10 Transition Required in the US?
    ICD-10 is a needed change to the over 30 years old ICD-9 coding vocabulary. ICD-9 has outdated terms and limited codes to capture current practices in medical care.  The ICD-9 structure limits the number of new codes that can be created.

    Who is Required to Transition to ICD-10?
    All HIPPA “covered entities” are required to use ICD-10 by October 1, 2015.

    How is ICD-10 Different than ICD-9?
    ICD-10 has over 68,000 codes, whereas ICD-9 has just over 14,000. ICD-10 has increased length of characters and a more flexible structure to allow creation of new diagnosis codes. ICD-10 has more accurate data for evaluating health care quality measures.

    What is the basic structure of the new ICD-10 codes?
    The basic structure of the new code is the following:

    Characters 1-3 – disease category
    Character 4 – etiology of disease
    Character 5 – body part affected
    Character 6 – severity of illness
    Character 7 – placeholder for extension of the code to increase specificity 

    How Do We Begin to Transition Our Practice?
    CMS recommends that medical practices take steps to prepare for implementation of the new code set years in advance. Not only must new software be installed and tested, but medical practices need to provide training for physicians, staff, and administrators. Practices will need to create crosswalks to convert ICD-9 to ICD-10 conversions around each encounter. Practices should check with their electronic medical record vendor to assure their encounter documentation will include the up to date standards as required by CMS.

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