CMS releases updates to ICD-10 flexibilities

CMS releases updates to ICD-10 flexibilities


The Centers for Medicare & Medicaid Services recently announced that it will be implementing a few changes after the ICD-10 deadline approaches. For example, the agency said that it will not deny claims within the first year of the new codes if specificity of ICD-10 diagnoses codes is off. The goal is to make the transition easier on health professionals who fear that the major change will cause setbacks within their practices.

However, after announcing the new flexibilities, the CMS noticed that many providers found them unclear. In response, the federal agency has release an updated version of its ICD-10 flexibilities to eliminate any gray areas.

CMS clarifies ICD-10 flexibilities
The CMS published frequently asked questions to give providers the chance to find explanations to any questions they may have regarding the new ICD-10 flexibilities. However, the agency found that there were two FAQs in particular that providers found confusing. These are the two flexibilities that the CMS aimed to clarify with its release of the new updates.

The first flexibility was announced at the beginning of July by the American Medical Association and the CMS explaining that Medicare providers will not have to worry about their claims being rejected for the first 12 months following ICD-10 implementation if they failed to properly specify one of the codes, but used the code in the correct family. However, many health professionals across the industry found what constitutes a valid ICD-10 code to be unclear.

What makes a code invalid?
Providers received an update on the announcement, which confirmed that a valid ICD-10 code must be submitted and ICD-9 codes will not be accepted after the deadline. However, it also stated that a three-character code can only be used if it is not subdivided any further than by four, five, six or seven characters. Medicare will process and not audit the valid ICD-10 codes unless they fall under circumstances in questions six and seven. The CMS also included a few examples of invalid codes in the update.

The explanation goes on to say that there is a full list of the codes and code titles that are valid in 2016 posted in tabular order on the CMS website. The CMS provided the list to offer straightforward assistance to providers who are having trouble determining whether the 4th, 5th, 6th or 7th character is needed while filing claims.

Before the Oct. 1 deadline, health professionals can use the list to practice selecting and using valid codes as a part of acknowledgement testing with Medicare, as the list will be available until Sept. 30, 2015. As acknowledgement testing is crucial to proper preparation for the new codes, providers looking for more information on the testing process should look over the Medicare Learning Network articles on testing or contact their Medicare Administrative Contractor.

What constitutes a family of codes?
Many providers understand that their claims will not be rejected if they make an error with the specificity of codes as long as they use them from the right family, but are confused as to what constitutes a family of codes. The CMS clarified, stating that the family of codes is the same as the three-character category for the ICD-10 codes. Each category contains codes that are clinically related, but provide differences in gathering specific data on the condition.

The CMS provided a few examples of codes in the same family, including H25.22, which is a code for morgagian age-related cataract in the left eye, and H25.9, which has four characters, but represents unspecified age-related cataract.

Providers should look to these updates and clarifications to ensure that they are on the right track for ICD-10 preparation and that there are no gray areas that could potentially cause setbacks after Oct. 1.