ICD-10 ‘Flexibilities’ Draw to a Close October 1

ICD-10 ‘Flexibilities’ Draw to a Close October 1

The CMS has issued an updated questions and answers page to better guide providers in using ICD-10 codes, which were finally implemented after much delay and controversy last October, but not before the American Medical Association and other groups extracted concessions from the CMS.

The concession that for one year following the ICD-10 start date, providers would be granted some ‘flexibilities’ in that they would not deny physicians and other practitioners Part B claims as long as they used a valid code from the correct family.

The CMS document stresses that providers should already be coding to the highest level of specificity and that many already are because “many major insurers” did not offer flexibility.

Many of the questions and answers in the new Q&A address the exceptions and what happens when they end on Oct. 1 this year.

For example, Question 26 asks, “How do I get ready for the end of flexibilities?” The CMS advises providers to avoid using so-called “unspecified” codes when documentation of the patient encounter supports a more detailed ICD-10 code. “Check the coding on each claim to make sure that it aligns with the clinical documentation,” the page says.

The CMS added even with the end to the flexibilities, it is well prepared to process new codes going into effect this fall. “As demonstrated by the successful ICD-10 transition, CMS is well equipped to handle changes to codes and to processes, and we do not anticipate any delays,” it stated.

The CMS also offers a state-by-state list of ICD-10 resources and contact information, including phone numbers of Medicare administrative contractors and state Medicaid offices.