ICD-10 Transition: So Far So Good, But There is More to Come
Written by Editor   
Tuesday, November 10, 2015 06:57 PM

The new ICD-10 diagnostic codes that took effect on October 1 aroused fears. Five weeks into the ICD-10 era the word from all quarters of the healthcare industry is that other than for some hiccups, wrinkles, and annoyances, physician practices are successfully submitting claims with the new codes and getting reimbursed by third-party payers — so far.

The Centers for Medicare and Medicaid Services (CMS) declared some preliminary good tidings about ICD-10 last week. From October 1 through October 27, the percentage of Medicare claims summarily rejected because of incomplete or invalid information, like a bad code, was unchanged from the historical baseline of 2%. During that time, the agency's Medicare administrative contractors (MACs) were processing claims for services rendered before October 1 and bearing the old ICD-9 codes, and for services rendered after the ICD-10 go-live date. Claims rejected because of invalid ICD-10 codes accounted for only 0.09% of all claims submitted.  In addition, the percentage of processed claims denied for payment during that period — 10.1% — was just a tick above the historical baseline of 10%, according to CMS.

Experts attribute these calming trends in part to Medicare's decision this summer to give physicians credit for less-than-perfect ICD-10 coding at the outset. The agency announced that for the first 12 months of the rollout, it would not deny claims based solely on code specificity as long as the physician chose a valid code from the right category or family for the condition. A number of private health insurers have followed Medicare's lead on coding flexibility.

This foretells the need to continue your study of ICD-10 in the future as shifts in documentation and coding demands continue to evolve.

Source:  http://www.medscape.com/viewarticle/854028