Physician Practice

ICD-10-CM grace period ends October 1

Physician Practice Insider, September 6, 2016

CMS’ grace period for reporting families of ICD-10-CM codes is coming to a close. Physician practices have less than a month to ensure billing and coding staff are fully trained and able to select the correct ICD-10-CM code—not merely those within the same family of codes. The agency reminded providers of the approaching deadline in an updated FAQ document released in August.

When ICD-10-CM was launched last year, CMS said it would allow providers billing Part B physician fee schedule codes a one-year grace period to fully ramp up. During the grace period, the agency would not deny physician claims as long as the codes on the claim were from the correct family of codes and met medical necessity. In an FAQ from July 2015, CMS defined a family of codes as the ICD-10-CM three-character category. Codes in a given category are clinically related but capture different specific information about a condition.

After October 1, coders must select codes at the maximum level of specificity as supported by the provider’s documentation. Physician practice coders should review the list of 2016 valid codes and the new codes that will come into effect in 2017.

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