As a reminder, today is the official ICD-10 implementation day, and all claims with dates-of-service (DOS) on/after October 1, 2015 must be submitted using ICD-10 diagnosis codes. Below is a list of ICD-10 reminders from the American Medical Association (AMA) and ACCMA resources to help your practice continue to navigate through the transition.

ICD-10 Reminders

1. ICD-10 has not been delayed. The deadline to switch to ICD-10 remains October 1, although CMS has agreed to flexibilities for Medicare Part B claims that should help make that transition smoother. Click here to read the most recently released CMS Guidance on ICD-10 Part B Claims Processing and Remittance Advice.

2. Medicare claims with a date of service on or after October 1 will be rejected if they do not contain a valid ICD-10 code. ICD-10 is composed of codes with between three and seven characters. Codes with three characters act as the heading of a category of codes and can either be further subdivided to provide greater specificity (which would add characters) or stand alone.

For example, C81—Hodgkin’s lymphoma—cannot stand alone and is not a valid code. But it can be further subdivided into C81.00 (nodular lymphocyte predominant Hodgkin lymphoma, unspecified site), C81.03 (nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes) or a few other options.

In this example, using any one of the valid codes for Hodgkin’s lymphoma would not be cause for a rejected claim or an audit under the recently announced flexibilities for Medicare Part B claims.

A complete list of valid codes and code titles is on the CMS website and listed in tabular order, the same order in the ICD-10 codebook.

3. A “family of codes” is the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For example, category H25—age-related cataract—contains a number of specific codes that captures information about the type of cataract and information on the eye involved.

With few exceptions (described in more detail below), Medicare Part B claims will not be denied or subject to an audit solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.

4. Certain claims fall outside of the coding flexibility. In certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an applicable policy, such as Local Coverage Determinations or National Coverage Determinations. Check CMS’ document for more information.

5. These flexibilities do not extend to prior authorization requests. The flexibilities only pertain to claims processing and post-payment reviews. ICD-10 codes with the correct level of specificity will be required for prepayment reviews and prior authorization.

6. CMS’ changes do not affect Medicaid or commercial payers. The official guidance only applies to Medicare fee-for-service claims from claims by physicians and other practitioners that are billed under the Medicare Fee-For-Service Part B physician fee schedule. It does not apply to claims submitted for beneficiaries with Medicaid coverage. Check CMS’ document for more information.

The AMA continues to seek similar commitments from major commercial firms.

Click here to view the AMA's "6 Things You Need to Know About the ICD-10 Transition."

ACCMA ICD-10 Program Resources

ACCMA's free comprehensive ICD-10 training program, "Charting a Path" to ICD-10 includes:

  • Recorded Webinars: over a dozen pre-recorded webinars covering all 21 chapters, how to plan a smooth transition, and a new session on "Documentation for Physicians and Other Clinicians"
  • Tools and Guidance: ICD-10 coding scenarios with answers and explanations, a planning template, a cost calculator, and guidance on specialized topics like neoplasms and diabetes
  • Specialty Tracks: developed for over 22 different specialties, these guides point you to the core content that applies to your specialty, including links to additional external resources
  • "Ask the Expert" Webinars: through October 2015, ask coding expert Mary Jean Sage specific ICD-10 questions and walk through various ICD-10 coding scenarios
  • *New: addition of new coding scenarios periodically throughout the end of the year or as needed
For assistance accessing these resources or for questions, please contact the ACCMA at (510) 654-5383, or by email at accma@accma.org.