ICD-10 'flexibilities' to expire Oct. 1 as planned

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A 12-month grace period meant to ease providers' transition to Medicare ICD-10 will officially come to a close on Oct. 1, Centers for Medicare & Medicaid Officials said last week.

In an update to a ICD-10 question and answer sheet, CMS confirmed the “flexibilities” will expire one year from the official roll-out of the new codes, with no extension or additional flexibility guidance planned. Under the flexibilities, providers' claims were not denied or audited for unintentional code errors as long as they contained a valid code from the correct “family.”

The update also confirmed that Medicare will not phase in a requirement to code to the highest level of specificity, stating “providers should already be coding” to that level.

“ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud,” the update reads. “As of October 1, 2016, providers will be

required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines.”

Many providers are already using specific codes, the guidance noted, since many major insurers chose not to offer coding flexibility.

To prepare for the end of the grace-period, CMS encouraged providers to avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. The agency also noted that many providers have made the switch from ICD-9 to ICD-10 with “essentially no adverse effects on coding accuracy.”