ICD-10: Lack of code specificity in first year will not cause claims denials


The Centers for Medicare & Medicaid Services (CMS) announced on July 6 that it would work with the American Medical Association (AMA) on easing the transition to ICD-10 (the International Classification of Diseases, 10th revision) this fall.

In a joint press release, CMS and the AMA announced that providers will not be penalized during the first year of ICD-10 use if their diagnosis codes are not specific enough, as long as the codes are from the proper code “family.” Medicare Administrative Contractors (MAC) and Recovery Audit Contractors (RAC) have been instructed not to deny physician or other practitioner claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code. This same policy will also apply to reporting for the Physician Quality Reporting System, Meaningful Use and CMS value-based payment programs.

CMS is also teaming up with the AMA to provide webinars, on-site training and other tools to teach doctors about the new codes.

ICD-10: Lack of code specificity in first year will not cause claims denials

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