New ICD-10 Codes; Grace Period to End

ICD-10 is back in the news, as the one-year anniversary of its U.S. implementation — Oct. 1, 2016 — approaches. With that date also comes the end to a couple of first-year breathers.

The Medicare one-year grace period on code specificity will end Sept. 30. For the first year of ICD-10, Medicare has been paying incorrectly coded claims as long as the incorrect code was from the right ICD-10 code family. Starting Oct. 1, you’ll need to make sure your medical record documentation supports codes to full specificity, and bill Medicare with those codes. If not, Medicare will deny payment or may penalize you in a post-payment audit. 

Because most major payers didn’t honor the grace period, however, you may already be using the correct, specific codes. If so, the end of the grace period will be a nonevent for you. Still, be alert for any adjustments that commercial payers might make in payment policies related to code specificity.

In August, Medicare updated its Q&A document clarifying code specificity.

The partial freeze on ICD-10 codes has ended, and a raft of new codes will become effective Oct. 1. According to the American Medical Association, ICD-10-CM will have 2,305 new codes, 553 revised codes, and 212 deletions. Although changes are spread across the ICD-10 code book, as with ICD-10 in general, only some codes will apply to your practice. Make sure to incorporate those codes into your internal practice processes. Also, verify with vendors that they support the new codes, and do some in-house testing to make sure your process will run smoothly come Oct. 1.

2017 ICD-10 update files are on the Centers for Medicare & Medicaid Services website. As a reminder, you should always have a version of the most recent coding books in your office. TMA members can buy the 2017 ICD-10 code book, and other code books, at a substantial discount from InGauge Healthcare Solutions, as part of TMA’s group discount programs. You also can preorder the ICD-10 book from sources like AMA, AAPC, and Amazon.

Anytime is a good time to brush up on coding and documentation skills. TMA can help with courses in the TMA Education Center, and review, training, and checkups from TMA Practice Consulting. Plus, registration is open for TMA’s E&M Coding Made Easy live seminar in San Antonio on Sept. 14 and Corpus Christi on Sept. 22. And you’ll find more resources on the TMA Coding webpage.

Published Aug. 26, 2016

Last Updated On

December 06, 2016

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