Medicare Program Announces Adjustment to ICD-10 Codes

The Medicare program announced yesterday that ICD-10 diagnostic claim codes will get a one-year grace period. The new regulation says that they will not be rejected for payment for the simple reason that the ICD-10 code submitted is not specific enough.

These codes are very long and numerous. However, the Centers for Medicare & Medicaid Services (CMS) says the they are important as a new code system will help to modernize patient care and research and, perhaps more importantly, prevent billing fraud.

“ICD-10 has very little to do with physician payment,” explains Sue Bowman, who is the AHIMA senior director for coding policy and compliance. She goes on to say, “On the hospital side, it drives the DRGs and all kinds of payment issues. On the physician side, their payment rates are driven by the CPT codes.”

Indeed, the American Medical Association (among others) say that ICD-10 is just another regulatory burden that will cost physicians upwards of tens of thousands of dollars.

Bowman continues, “It’s not true that [physicians] have to document in ICD-10 PCS lingo. There’s actually a coding guideline that says the physicians can document their procedures the way they always have, and it’s up to the hospital coder to translate the physician’s description of [procedures] to ICD-10 PCS codes. But only hospitals are going to be using those codes, not physician practices.”

Finally, Bowman says, “There’s a lot of research analysis that’s done based on claims data that uses that diagnosis and procedure data for a lot more ways than beyond just how that claim got paid, to be able to assess difference in resource utilization, difference in outcomes for different kinds of treatment, [and resolving] patient safety issues.”


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