Final countdown: Get answers to your ICD-10 coding questions

September 30, 2015
AOA’s Coding Experts share solutions to your ICD-10 questions.

Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.

From the September 2015 edition of AOA Focus, page 49.

After years of discussion, preparation and deadline extensions, the ICD-10 compliance deadline is just 24 hours away. On Oct. 1, all providers covered by the Health Insurance Portability and Accountability Act (HIPAA) must adhere to the new codes. AOA's Coding Experts offer solutions to common coding conundrums.

If I use the wrong ICD-10 code when billing Medicare after Oct. 1, will my claim be denied?

The Centers for Medicare & Medicaid Services (CMS) announced in July that for 12 months after the Oct. 1, 2015, ICD-10 implementation date, Medicare review contractors will not deny physician claims based solely on the specificity of the ICD-10 diagnosis code as long as the physician used a valid code from the right family. Note that this is not a delay of ICD-10 implementation. Please remember that a valid ICD-10 code will be required on all claims starting on Oct. 1, 2015.

Read the complete CMS guidance.

What happens if I use the wrong ICD-10 code for quality reporting in PQRS or for the EHR Meaningful Use Program after Oct. 1, 2015?

For all quality reporting in 2015, physicians will not be penalized as long as the physician used a code from the correct family of codes. Furthermore, CMS has indicated that a physician will not be subjected to a penalty if CMS experiences difficulty calculating quality scores due to the transition to ICD-10 codes.

Where can I go for help with transitioning to ICD-10 after October 1?

AOA members can contact AOA's Coding Experts any time with questions by visiting asking the coding experts.

Additionally, CMS is setting up a communication and collaboration center intended to identify and resolve ICD-10 issues. CMS has indicated the agency also will have an ICD-10 ombudsman to help receive and triage physician and provider issues. AOA will update members as more information regarding the ombudsman is made available.

Ask the coding experts

If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.

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