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

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

Click here to 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.

Click here to obtain the listing of appropriate ICD-10 codes for PQRS measures that relate to optometry.

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

Optometrists are encouraged to review the 11-part ICD-10 webinar series available at

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.

September 30, 2015

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