Medicare Announces Plan to Ease ICD-10 Transition

Under pressure from the AMA, CMS recently announced a new plan to ease the ICD-10 transition and prevent significant payment disruptions. The main component of the new plan is that CMS will establish a one year period during which it will not deny claims solely for lack of specificity in the ICD-10 diagnosis, so long as the diagnosis provided is in the correct family.

For example, under this new rule, Medicare should allow S92.309A (Metatarsal fracture, unspecified bone, un- specified foot, initial encounter), even though a correct, specific code would be one such as S92.332A (Displaced fracture, 3rd metatarsal, left foot, initial encounter).

Medicare also announced that they will make advanced payments available to providers if ICD-10 causes signif- icant internal delays in claim processing that are no fault of the provider. Medicare will release details on how to obtain payment at a later time if necessary.

While this new transition period should help limit denials due to ICD-10 coding difficulties, it is only scheduled to last for 12 months. Providers should continue to study ICD-10 coding in order to understand the full level of specificity necessary for documentation and correct code selection.