CMS, in collaboration with the American Medical Association, issued an updated FAQ regarding ICD-10 concerns in early July 2015. In the notice, CMS indicated that ICD-10 errors regarding specificity would not be denied by Medical Review contractors for 12 months after implementation.
“While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner 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 physician/practitioner used a valid code from the right family.”
CMS will still be enforcing the requirement of a valid ICD-10 code post implementation, however the regulation on specificity as it pertains to medical review will be more relaxed for the next year for practitioner claims. While this relaxation does not directly impact DME claims, it may be a sign of future directives to contractors when editing based solely on diagnosis codes. Future LCDs for diagnosis driven DME products have already been posted to the CMS website...
“While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner 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 physician/practitioner used a valid code from the right family.”
CMS will still be enforcing the requirement of a valid ICD-10 code post implementation, however the regulation on specificity as it pertains to medical review will be more relaxed for the next year for practitioner claims. While this relaxation does not directly impact DME claims, it may be a sign of future directives to contractors when editing based solely on diagnosis codes. Future LCDs for diagnosis driven DME products have already been posted to the CMS website...
For DME claims like nebulizer equipment, accessories and medication or Group 2 support surfaces and CPAP equipment which are diagnosis driven, these documents will be the primary source of ICD-10 diagnosis enforcement. However in this announcement, CMS also indicated that they will be naming a CMS ICD-10 Ombudsman in the coming months to “triage and answer questions about the submission of claims”.
CMS has released a number of tools to assist providers in the transition including a General Equivalency Mapping and a dedicated ICD-10 webpage. If you have concerns about the speed and advancement of your company’s ICD-10 transition, MiraVista has put together a tool that will not only help you identify your most vulnerable codes, but it will also map them to the ICD-10 equivalent(s)…within minutes. Our programming team has created this tool utilizing the General Equivalency Mappings from CMS. The tool will plug in exported active rental data from your billing software and provide you with:
If you are interested in additional details regarding this tool, please contact us at icd10@miravistallc.com.
CMS has released a number of tools to assist providers in the transition including a General Equivalency Mapping and a dedicated ICD-10 webpage. If you have concerns about the speed and advancement of your company’s ICD-10 transition, MiraVista has put together a tool that will not only help you identify your most vulnerable codes, but it will also map them to the ICD-10 equivalent(s)…within minutes. Our programming team has created this tool utilizing the General Equivalency Mappings from CMS. The tool will plug in exported active rental data from your billing software and provide you with:
- A list of your most popular ICD-9 codes so that you can educate your staff and referral sources.
- A classification for each code determining whether it is a one-to-one or one-to-many match.
- A mapping from each ICD-9 code to the ICD-10 equivalent(s).
- A list of the order numbers appended to each diagnosis code so that you can quickly identify which patients require intervention.
If you are interested in additional details regarding this tool, please contact us at icd10@miravistallc.com.
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