ICD-10 Grace Period Coming to an End

Medicare’s one year ICD-10 grace period to ease the transition is set to expire next week on October 1st. Medi- care announced the grace period in agreement with the AMA to prevent denials for lack of specificity in diagno- sis coding, so long as providers supplied codes in the right “family.”

We have no way of knowing how strict Medicare will be after the October 1st deadline. Certain procedures and supplies already have strict diagnosis limitations on them that seem out-of-step with the promised grace period. Furthermore, Medicare has been moving away from providing lists of covered codes in their Local Coverage Determinations, and instead only providing general guidelines.

To best protect yourself from the upcoming change, remember to select codes with the most specificity. Always include location and laterality, and never use an unspecified code. Many ICD-10 fields include codes marked as “other specified,” which is a better last resort than using “unspecified.”

HCA will monitor outgoing charges after the deadline to check for any surprise denials due to the end of the grace period, and provide updates accordingly. If you have any questions regarding best coding practices, please contact Dave or Ben.