With end of ICD-10 grace period looming, docs must be mindful of code specificity

As the end of the first year under ICD-10 fast approaches, physicians who file claims under the Medicare Part B physician fee schedule must be mindful that the end of the one-year grace period for post-payment reviews also looms.

The grace period, which applies to code specificity, was announced last July in a joint statement from the Centers for Medicare & Medicaid Services and the American Medical Association, and was a key factor to ensuring the long-awaited transition would not be delayed, yet again.

According to Christine Lee, a manager of provider practice audit services at Ciox Health, providers must take several steps to ensure that the end of the grace period does not negatively impact their coding efforts. Two important steps include examining any instances of and patterns behind the use of unspecified codes, and reviewing electronic medical record software for potential glitches, she said in a post for AHIMA's ICD-TEN.


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"While there are a few instances where usage of unspecified ICD-10-CM codes may be appropriate, widespread use of numerous unspecified codes should be the exception, not the rule," Lee writes. "Practices submitting unspecified ICD-10 codes after Oct. 1, 2016, may potentially experience an increase in post-payment audits and quality reporting errors."

As far as the EMR review, Lee says that because many practices count on such tools to determine which codes to use, glitches could cause claims rejections.

A survey published earlier this month by the Workgroup for Electronic Data Interchange found that the transition had a neutral impact on productivity for responding providers. While most respondents said costs were in line with expectations or higher, some providers reported that costs were less.

In February, CMS Acting Administrator Andy Slavitt touted the effort put forth by his agency and the industry at large to make the shift last October, saying that the "Y2K fears" expressed by some never materialized.

To learn more:
- here's the post

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