Christiana Care Health SysytemICD-10

August 3, 2015

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: or
Call the ICD-10 Team at 302-327-7628.


Feedback? Questions? Send us an email or call 302-327-7628