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Ten to 10
Week 8
A few weeks ago, the Center for Medicare & Medicaid Services (CMS) announced that they will wait one year to begin denying physician claims for lack of ICD-10 specificity, provided the codes are in the same “family”. This leniency does not extend to hospital or home health claims. On 7/27, CMS issued further clarification on their definition of “family”.
What do I need to know?
- Valid ICD-10 codes must be used beginning October 1, 2015.
- CMS is defining a family as the first 3 characters of the code.
- The first 3 characters, also referred to as a category, are clinically related yet differentiate types of a particular condition. For example:
K50 (Crohn’s Disease)
- 3 character families almost always require further subdivision, utilizing characters 4-7. For example:
K50.00 Crohn’s Disease of small intestine without complications
K50.012 Crohn’s Disease of small intestine with intestinal obstruction
K50.90 Crohn’s Disease, unspecified, without complication
- Clinical documentation should be as specific as the code that is chosen to support its use.
What do I need to do?
- Remember that this CMS announcement does not delay the October 1, 2015, implementation of ICD-10. It only delays specificity denials for one year. Prepare now to avoid negative financial repercussions in the future.
- Review translated documents that you have received from the ICD-10 team or experiment with the I-Search tool, to review the family of your commonly used diagnosis codes. Ask yourself:
- Where would our documentation need to be more specific to coincide with the specificity of the code?
- Where do I think our providers or staff may need help understanding the differences between specific codes?
ICD_10 Fact
More than one-third of the increase in the number of codes is due to laterality (left vs. right).
For more information: http://www.christianacare.org/icd-10-resources or
Call the ICD-10 Team at 302-327-7628.
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