As of October 1, 2015 all health care entities covered by the Health Insurance Portability and Accountability Act (HIPAA) are required to use ICD-10 codes in place of the existing ICD-9-CM code set for medical diagnoses. ICD-10 is a more detailed system that will allow for collection of more specific data about patient diagnoses. ICD-10 codes are 3-7 digits compared with the 3-5 digits in ICD-9-CM.
NASS has developed a crosswalk of ICD-9-CM codes commonly used in spine care to the new ICD-10 codes. These recommendations reflect the opinions of the NASS Coding Committee and do not constitute an official position or statement by NASS.
CMS & AMA Announce Efforts to Help Prepare for the Transition to ICD-10
Medicare claims will not be denied solely based on ICD-10 coding errors for one year beginning October 1.
Together, the American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) announced on July 6, 2015 that an agreement has been reached on the issue of a “grace period” for the October 1, 2015 implementation of the ICD-10 diagnosis code set.
CMS released the following information:
For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
The AMA will monitor implementation and let CMS know of any issues that arise during the transition so that they can make any necessary adjustments to the grace period policies and the timeline that has currently been put in to place.
NASS has developed a crosswalk of ICD-9-CM codes commonly used in spine care to the new ICD-10 codes. These recommendations reflect the opinions of the NASS Coding Committee and do not constitute an official position or statement by NASS. Watch the NASS website for additional information on webinars and other resources as the transition deadline approaches. The AMA also has a broad range of materials available on its web site to help physicians prepare for the October 1 deadline.
Information on ICD-10 will be incorporated into the 2016 NASS Coding Courses. Watch the NASS website for additional information on webinars and other resources as the transition deadline approaches. Additionally, the Centers for Medicare and Medicaid Services (CMS) has numerous resources designed to assist in implementing ICD-10.