ICD-10: Some Worker's Comp Insurers May Opt out of ICD-10, CMS Says

Why This Topic Matters

The article helps readers understand which parts of the ICD-10 transition are firm, which payer groups are included, and how CMS is approaching system readiness and coverage policy conversion. It is relevant for practices planning internal testing, coordinating with trading partners, and tracking payer-specific implementation differences.

Article Sections

1. CMS ICD-10 implementation timeline and policy update context

   This section discusses the timing of the ICD-10 transition and CMS communication about prior guidance and implementation-date changes. It also addresses how CMS is handling older policy materials during the transition.

2. National Coverage Determinations and translation to ICD-10

   This section explains CMS’s work on updating coverage policies for the new code set and notes that not all existing determinations are being translated. It also describes the broader scope of coverage policy content affected by the transition.

3. Example of a revised CMS policy

   This section presents a CMS policy update example tied to a specific covered service and related diagnosis-grouping framework. It illustrates how policy materials may reference both historical and updated diagnosis code information.

4. Internal testing and trading partner readiness

   This section covers CMS guidance on internal testing and the limits of direct claim testing with CMS. It also discusses coordinating testing with intermediary organizations.

5. Clearinghouses, 5010 readiness, and payer applicability

   This section focuses on transaction-standard readiness, clearinghouse limitations, and which payer groups are included in the transition. It also addresses workers' compensation payer variability and related billing coordination.