To be properly reimbursed, accurate descriptions of the service being provided are needed. Billing codes, including CPT, are used to describe the procedure or treatment being provided, in order to be adequately reimbursed for practice expenses and physician effort. ICD-10 codes are used to describe the diagnosis that brings the patient to seek care.
In new guidance, CMS announced:
- 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.
See these documents and websites for more information:
- CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
See a list of commonly used addiction treatment related ICD-10 codes.
AMA ICD-10 Transition Resources
ICD-10 FAQ from CMS
Road to 10: The Small Physician's Practice Route to ICD-10
ICD-10 Clinical Concepts Series: Family Practice
American College of Physicians: ICD-10 Tips
CMS FAQs about Claims Spanning October 1, 2015