"Relaxed" ICD-10 Rules End October 1


Physician practices have had nearly a year to acclimate to the ICD-10 coding that took effect in October 2015. Thanks to a grace period known as ICD-10 "relaxed rules," established by the Centers for Medicare & Medicaid Services (CMS), the use of ICD-10 codes that did not meet the highest level of specificity requirements were allowed to continue without the risk of penalty.  CMS instructed Medicare contractors to not deny claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the provider used a valid code from the correct family.  This granted a reprieve for practices, allowing them more time to adapt to the vast new code set.

The one-year grace period ends on October 1, 2016. After this deadline, CMS requires a valid ICD-10 code for all claims.  Providers continuing to use ICD-9 codes may face increased claims denials, as Medicare and private payers are expected to enforce more stringent diagnostic coding requirements. Specifically, Medicare review contractors will now be able to reject billed claims based solely on specific ICD-10 diagnostic codes, while CMS no longer will authorize advance payments to providers whose claims under ICD-10 were being delayed.

CPMA/APMA members can find ICD-10 resources at www.apma.org/ICD10.  Members are also eligible for discounted access to the APMA Coding Resource Center. This freshly updated APMA resource has ICD-10 codes and crosswalks, and features a streamlined look as well as faster processing and search times at www.APMAcodingrc.org.