CMS Clairfies - A Valid Code and What will be paid

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 31st, 2015

Do you recall the article sent out on July 6, 2015 from CMS and the AMA on being flexible with ICD-10, giving us a one year grace period?  This has article has been misinterpreted and misrepresented in so many shapes and forms.  Many rumors in the health care community is that; "CMS will not deny our claims!". I have seen articles on the internet, (we all understand; if it on the internet it must be true), stating this exact thing.  This is simply not true, even if it was true, what about the private payers?

Beware; your claims can and will still get denied.  CMS recently send out an article clarifying exactly what they meant about the ICD-10 Flexibilities. 

First and foremost  - There is still no delay.  ICD-10 is required to be used on all claims with a date of service on or after October 1, 2015.

What is a valid ICD -10 code? CMS clarified this as of 7/31/15 by stating they will still  deny a code that is not recognized as a valid code.

 If you are not familiar with ICD-10 and are unable to recognize a valid code, you need to get educated and in a hurry.  It is not a simple mapping or a just a change in code sets.  InstaCode  Institute has a Guide to ICD-10 as well as many speciality specific books to help your understanding and teach you the basics of ICD-10-CM.

Medicare stated they are not changing the current automated claims processing edits, you need to follow your Local Coverage Determinations (LCD's) as well as other edits put in place by CMS.  Processing edits will not be changed to accommodate families of codes or unspecified codes. 

Check out some helpful books to get your started ICD-10 Speciality Specific code books and Quick Start Guide from InstaCode Institute.