CMS Clarifies "Guidance Regarding ICD-10 Flexibilities"
Written by Editor   
Wednesday, August 05, 2015 07:28 AM

 The CMS recently released a Q&A statement that addressed several questions regarding guidance for the implementation of the ICD-10 coding system.  Read important points in this report.

In a release dated July 27, 2015 CMS presented a Q & A that addressed several outstanding questions with regard to the promised guidance and "flexibility in the claims auditing and quality reporting process." A few of the important points are listed below:

  • The recent Guidance does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10.

  • "Family of codes" is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition.

  • To be valid, a code must be coded to the full number of characters required for that code, including the 7th character, if applicable.

The aforementioned statements by CMS confirm the fact that providers will be required to code with ICD-10-CM starting October 1, 2015. They will also need to provide a specific diagnosis, as was required in ICD-9 from the correct code category in ICD-10. A provider cannot meet these requirements by coding from a shortcut list of diagnosis codes or from crosswalks. Rather they will need to consult a coding manual in order to find all the instructional notes, descriptions, coding requirements and level of specificity offered within each code category. 

Check CMS' website for your local MAC's posting of future ICD-10 diagnosis codes. Step by step directions on how to locate your LCD are available here. Please note, on step #4 we suggest that you choose LCDs by state (rather than contractor). Once you check LCDs by state and submit, two or three listings for your MAC may appear. Click these and scroll down the alphabetic list until you  find "chiropractic services."


Source:  American Chiropractic Association