Health Information Management

ICD-10 is here: Now what?

HIM-HIPAA Insider, October 20, 2015

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After months and years of preparation, false starts, and delays, ICD-10 is here and medical practices large and small are now wading into the deep end of this new coding set pool for the first time.

While it will still be several months before physicians, clinicians, and analysts can determine how well the transition has gone, the AMA won several concessions for physicians this summer when CMS agreed to loosen some standards and not issue penalties for errors that are linked to reasonable mistakes.

\Under the agreement, CMS will not deny or audit claims for specificity as long as the code in question is from the appropriate family of ICD-10 codes. In the same vein, CMS also agreed not to penalize physicians under the now-mandatory Physician Quality Reporting System or meaningful use linked to the specificity of a diagnosis so long as providers use a code that is from the appropriate family of codes.

The changes were welcomed by several groups, including the American Academy of Family Physicians (AAFP), which had petitioned CMS alongside the AMA for some type of grace period on penalties.

“The AAFP has advocated for several of these changes, including a one-year grace period on coding specificity within families of ICD-10 codes, which will enable family physician offices to keep up with the ICD-10 transition without threatening their financial viability,” says AAFP president Robert Wergin, MD. “We are gratified that CMS has addressed our concerns in a substantive way. These changes will ease the transition to ICD-10 for family physicians and alleviate the threat of claims disruptions, which could devastate family physician practices.”

AMA president Steven Stack, MD, says the grace period “means that Medicare will not deny payments for these unintentional errors” as practices adjust to the new coding system. “These provisions are the culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change,” says Stack.

But the grace period does not give practices the option of postponing the transition. In its July decision, CMS made it clear that “Medicare claims with a date of service on or after October 1, 2015, will only be accepted if they contain a valid ICD-10 code” and that it “won’t accept ICD-9 codes for dates of service after September 30, 2015, or accept claims that have both ICD-9 and ICD-10 codes.”

While most people are happy with the reprieve from CMS, there’s some uncertainty on what the agency means when it refers to a “family of codes,” given that many codes have subcategories with smaller groups of subcategories within them.

“I think it’s a good move on the part of CMS as long as they’re clear on what degree of error they’re talking about when it comes to a family of codes,” says Judy Larson, CPC, billing manager for Rockford Orthopedic Associates in Illinois.

Nevertheless, Larson feels confident her group is as prepared as it can be for the launch of ICD-10 this month. She’s been working on the transition since 2011—back when the launch date was slated for 2013—and after four years and dozens of in-house training sessions with her staff, Larson looks forward to the launch.

“I would say that we’re as prepared as we can be,” she says. “We’ve had 51 training sessions and we’ve been working on this since 2011, so we’re ready to get rolling.”

This article is excerpted from HCPro’s The Doctor’s Office. Click here to read more.

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