The Centers for Medicare & Medicaid Services (CMS) recently issued questions and answers (Q&As) on International Classification of Diseases, Tenth Revision (ICD-10) guidance issued by CMS and the American Medical Association.
For 12 months after ICD-10 implementation, CMS will not deny claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code. However, a practitioner must use a valid code from the correct family of codes. Codes in the same family are codes within the same ICD-10 three-character category.
The recent guidance does not change the coding specificity required by National Coverage Determinations and Local Coverage Determinations. Coverage policies that require a specific diagnosis under International Classification of Diseases, Ninth Revision (ICD-9) will continue to require a specific diagnosis under ICD-10. The coverage policies will not require greater specificity in ICD-10 than was required in ICD-9, except for laterality, which does not exist in ICD-9.
Medicare claims with a date of service on or after October 1, 2015 must contain a valid ICD-10 code.
The Q&As are available at:
The CMS and AMA guidance is available at:
Centers for Medicare & Medicaid Services. “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.” 27 Jul. 2015.
Centers for Medicare & Medicaid Services and the American Medical Association. CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10. 6 Jul. 2015.