3 Ways to Avoid Denials When CMS Stops ICD-10 Grace Period in October 2016
Written By Sandeep Paranjape | NextServices
October 2016 marks the end of a year long grace period for ICD-10 by Centers for Medicare and Medicaid (CMS). Providers haven’t seen many denials related to ICD-10 during the past year because even private insurance companies followed Medicare with payment flexibility for ICD-10. Expect this to change as CMS updates its code set and implements 1,974 new codes starting October 1, 2016.
Here are three things to keep in mind while you prepare for shifting gears with ICD-10 implementation
1) New codes, modified codes and deleted codes.
Study the 1,974 ICD-10CM codes that will be added to the 2017 ICD-10CM code set effective October 1, 2016. Additionally, 425 ICD-10CM codes will have description changes and 311 ICD-10CM codes will be deleted in the new code set.
2) Minimize use of unspecified codes.
Expect to see denials or delays in payments if you do not identify specific diagnosis. CMS ignored the use of unspecified codes during the grace period and continued making payments but we are beginning to see signs that they will hold back payments when documentation is insufficient. Use unspecified codes very rarely, if at all. If you’ve setup any defaults in your EHRs for unspecified codes, remove them and be prepared to code more specifically.
3) Follow official CMS ICD-10CM coding guidelines for 2017.
The 100+ page guidelines are rules that have been developed to accompany official conventions followed within the ICD-10 framework. Here’s the official link: ICD-10CM Official Guidelines for Coding and Reporting FY 2017.