Archive for August, 2016

August 25, 2016

The Flexibility Conundrum


CMS FAQ Update Reminds Providers: ICD-10 Flexibilities End October 1.
In a recent FAQ update, the Centers for Medicare and Medicaid Services (CMS) reminds providers: Flexibilities regarding the specificity of ICD-10-CM codes on Medicare physician/practitioner claims will come to an end on October 1. Last summer, CMS announced that for 12 months after the October 1, 2015, ICD-10 implementation, Medicare review contractors would not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated or complex medical record review based solely on the specificity of the ICD-10-CM diagnosis code, as long as the physician/practitioner used a valid code from the right family of codes.

The update also indicated that providers should already be coding to the highest level of specificity. Even with the ICD-10-CM flexibilities, a valid ICD-10-CM code has been required on all claims for dates of service on or after October 1, 2015. In addition, while unspecified ICD-10-CM codes should be avoided whenever documentation supports a more detailed code, unspecified codes are allowed because they have acceptable, even necessary, uses.

Although the “flexibility” period only applied to physicians, hopefully there will be a trickle down effect with documentation. We can only hope.