CMS Gearing Up for ICD-10 Implementation

The sound that is getting impossible to ignore is the clock ticking down to the implementation of the International Classification of Diseases, Tenth Edition (ICD-10) at 12:01 am on Thursday, October 1, 2015. All healthcare stakeholders 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 with ICD-10.

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 (

A similar policy will be followed by Medicare administrative contractors and recovery audit contractors. In addition, clinicians and practices will not be subjected to penalties in the Physician Quality Reporting System, the Value-Based Payment Modifier program, or the Meaningful Use program relating to the specificity of ICD-10 codes during primary source verification or auditing.

CMS staff will also not penalize practices if the staff encounters difficulties calculating quality scores for ICD-10 codes, as long as the codes are from the appropriate families.

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

CMS has also created—a website designed to help small physician practices start using ICD-10 on time.

For example, Lorie G. Fleck, MD, FACS, a urologist at Urology & Oncology Specialists PC, in Mobile, AL, is described on the website to be available as a “physician champion” for urologists who have questions or need mentorship with respect to ICD-10 implementation, but no contact information is provided on the website for Dr Fleck.

There are also listings of common codes for several specialties.

In addition, the website features webcasts on topics ranging from “Training and Preparation on the ‘Road to 10’” to “Clinical Documentation and Coding on the ‘Road to 10.’”

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