ICD-10: 5 FAQs Quell Confusion on CMS's Latest ICD-10 Announcement

Why This Topic Matters

It helps healthcare billing and coding professionals determine how CMS’s ICD-10 clarification may affect claim processing, payer policies, and issue resolution during the transition period.

Article Sections

1. Introduction

   Overview of CMS’s ICD-10 clarification and the questions it prompted among practices and providers.

2. Clarification 1: Is ICD-10 Delayed for A Year?

   Discussion of CMS’s statement on implementation timing and the Medicare scope of the guidance.

3. Clarification 2: How Do We Determine If the Code Is in the Right ‘Family?’

   Explanation of CMS’s terminology for code grouping and the general category concept used in the FAQs.

4. Clarification 3: If We Get A Denial, Will We Know Whether the Reason Involved An Incorrect ICD-10 Code Family?

   Information about claim rejection versus denial and how CMS describes identifying the cause of a claim issue.

5. Clarification 4: Does the One Year Grace Period Extend to Medicaid and Private Payers?

   Scope of the CMS guidance as it relates to Medicare, Medicaid, and commercial payer policies.

6. Clarification 5: When Can I Contact the Ombudsman?

   CMS’s update on the timing of the ICD-10 ombudsman role and its availability to Medicare stakeholders.