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Rheumatology Practice Management August 2015 Vol 3 No 4 - Coding and Billing, Online Exclusives
Rosemary Frei, MSc

Tick tock tick tock: that sound that’s getting impossible to ignore is the clock ticking down to 12:01 am on Thursday, October 1, 2015, when the new International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10 CM/PCS) takes effect. All stakeholders in the healthcare system are hearkening to the countdown and making sure that people are not squeezed out of the practice of medicine by insufficient time and support to comply.

For example, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association have granted a 1-year grace period: Medicare Part B claims will not be denied up to September 30, 2016, if there is a lack of specificity of the ICD-10 diagnosis codes, as long as the code is from the correct family of codes (see www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProvid erICD-10.pdf).1 A similar policy will be followed by Medicare administrative contractors and recovery audit contractors. In addition, CMS clinical quality data review contractors will not subject clinicians/practices to Physician Quality Reporting System, Value Based Modifier, or Meaningful Use penalties relating to specificity of ICD-10 codes during primary-source verification or auditing—nor will practices be penalized if the CMS staff encounter difficulties calculating quality scores for these—as long as the codes are from the appropriate families.

This is welcome news to the American College of Rheumatology (ACR).

“The ICD-10 guidance issued yesterday [July 6, 2015, outlining the 1-year grace period] is an important step toward establishing a reasonable and responsible transition to the ICD-10 code set,” Bill St. Clair, MD, President of the ACR and a practicing rheumatologist, was quoted as saying in a news release from the organization.2 “The ACR has been a vocal advocate for safe harbor protections, specifically those outlined in the ICD-TEN Act (H.R. 2247). The new guidance addresses many of our members’ concerns about the impact of ICD-10 on small and rural practices, and we will continue to work to ensure a stable transition in other areas.”

In another helpful move, the CMS is creating the position of ICD-10 ombudsman to resolve problems during the transition. The organization also will authorize advanced payments if Medicare contractors cannot process claims within established time limits due to problems with ICD-10 implementation.2

References

  1. Department of Health & Human Services, Centers for Medicare & Medicaid Services. CMS letter to providers about ICD-10 readiness. CMS.gov website. www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf. Published July 7, 2015. Accessed July 22, 2015.
  2. Rheumatology community applauds CMS guidance providing ICD-10 “safe harbor” period; encourages further action to ensure responsible transition [news release]. Atlanta, GA: American College of Rheumatology; July 7, 2015. www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/660/Rheumatology-Community-Applauds-CMS-Guidance. Accessed July 22, 2015.
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Last modified: September 18, 2015
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