CMS and AMA on ICD-10 Guidance for October 1, 2015
The Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) on July 27, 2015 in response to questions from healthcare providers released clarifications on their ICD-10 guidance for the medical diagnosis codes that take effect October 1, 2015.
CMS provided additional guidance on new ICD-10 codes for medical diagnoses and inpatient procedures, the ACA International reported earlier this month, in response to requests from the provider community. The information shows flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.
According to a news release from CMS, since the guidance information was released, healthcare providers sought confirmation on the:
- Implementation date,
- What constitutes a valid ICD-10 code,
- Filing claims and
- What to do if they are rejected, among other topics.
According to the release and response to a question from the provider community, the guidance and additional resources from CMS does not mean there is a delay in the October 1, 2015 implementation of the ICD-10 code set for Medicare or any other organization.
CMS and AMA also confirmed the availability of an ICD-10 ombudsman who will help in receiving and prioritizing the physician and provider issues. The ombudsman will be working closely with representatives in CMS?s regional offices to address Medicare providing physicians? concerns.
Valid ICD-10 codes include between three and seven characters and CMS has a complete list of the valid codes available at CMS or can be searched on our site.
Codes that are not valid can result in denial of a claim, but the good part is providers will receive confirmation the claim was rejected due to the code rather than another reason and procedures to follow to fix the claim.
CMS and AMA are taking efforts in providing educational resources including webinars, on-site training, articles and national provider calls to help physicians and other healthcare providers learn about the updated codes and prepare for the transition.
According to CMS, the use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.
In addition, CMS has multiple resources on its ICD-10 website.