ICD-10 date firm, but CMS offers some coding leeway

ICD-10 date firm, but CMS offers some coding leeway

New guidance from the Centers for Medicare & Medicaid Services (CMS) offers physicians a chance to gain experience with the greater specificity of ICD-10 amid the first year of implementation.

Wrongly coded claims will not be denied so long as doctors report from the appropriate code family.

The concession comes less than three months before the Oct. 1, 2015, deadline to fully transition from ICD-9 to ICD-10 codes, and after repeated concerns that the overnight transition would result in denied reimbursement from errors when using the intricate code set. That concern has factored in to ICD-10 implementation delays in the past; however, this new guidance does not postpone implementation.

Rather, the new guidance states that CMS "will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. However, a valid ICD-10 code will be required on all claims starting on Oct. 1, 2015."

This slight leeway is available for one year past the Oct. 1, 2015, implementation date, and is intended to help doctors complete the major coding transition without reimbursement denials so long as they report a code from the appropriate code family. However, the guidance does point out that a claim still could be chosen for review for reasons other than specificity of the ICD-10 code.

Use AOA member resources to prepare
While this new guidance helps ease the transition, it's still vitally important that doctors familiarize themselves with ICD-10 and be prepared for the transition deadline. Below are tools and resources AOA members can use to prepare:

  • Register for the "ICD-10 is Coming! Be Ready" webinar, presented by Rebecca Wartman, O.D., and held on July 14, 2015, at 8 p.m. EDT. Also find the 10-part ICD-10 webinar series developed by AOA's Third Party Center Coding Experts on EyeLearn.

  • AOA's Coding Experts are available to answer questions about ICD-10 and other coding topics through the online form available at aoa.org/ask-the-coding-experts

  • AOACodingToday.com, a no-cost, members-only, online resource that offers CPT/ICD-9/ICD-10 information

  • The 2015 Coding Bundle, which includes the 2015 AOA ICD-10 Codes for Optometry Book, 2015 AMA Professional Edition CPT Book and AOA Express Mapping Card. A digital version of the Codes for Optometry Book is also available.

Click here to access the AOA's Medical Records and Coding page, and click here to access ICD-10 tools and resources from CMS.

July 8, 2015

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