[{"innerBlocks":[],"name":"core\/freeform","postId":4225,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"While last year\u2019s ICD-10 transition went smoothly and with very few hiccups, healthcare organizations do not have the luxury of resting on their laurels. October 1 marks the one-year anniversary of the code switchover, which brings new challenges they must overcome.

Jim Daley, director of IT for BlueCross BlueShield of South Carolina and past chairman of the Workgroup for Electronic Data Interchange as well as WEDI\u2019s ICD-10 co-chair, credits the success of organizations in meeting the Oct. 1, 2015, implementation deadline to the fact the industry had a lot of time to prepare.

One year later, Daley contends that organizations must now focus on three significant changes that will come into play starting Oct. 1, 2016:

The ICD-10 Coordination and Maintenance Committee has lifted the partial code freeze and thousands of new codes have been added for federal Fiscal Year 2017, which begins October 1.<\/li>
The Medicare grace period on code specificity for Part B post payment audits will end Oct. 1, 2016. <\/li>
Payers may begin to adjust medical policies based on the new specificity offered by ICD-10.<\/li><\/ul>
According to Daley, the coding update to be implemented on Oct. 1, 2016, will include a backlog of changes to the code set proposed by the ICD-10 Coordination and Maintenance Committee. He notes the large number of new codes are a result of the fact that a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes that existed prior to the Oct. 1, 2015, ICD-10 transition deadline has been lifted.

The Centers for Medicare and Medicaid Services reports that there are 71,486 diagnosis and 75,789 procedure codes for FY 2017. These include 1,974 additions, 311 deletions, and 425 revisions for ICD-10-CM, and 3,827 additions, 12 deletions, and 491 revisions for ICD-10 PCS, respectively.

\u201cThe impact of those new codes depends on what you do for a living,\u201d says Daley, who argues that it\u2019s important to determine the applicability of the new or revised codes specific to your practice or facility. \u201cIf you don\u2019t happen to deal with the areas where the codes have changed, the impact will be obviously a lot less than if they\u2019re right in the middle of your specialty.\u201d

He recommends that organizations make sure that applicable codes are incorporated into internal applications and processes, while verifying that vendor products support the new codes. In addition, Daley warns not to rely solely on software vendors for testing.

\u201cI would think that most of the major vendors are on top of this and are up to date, but you certainly don\u2019t want to have new codes rejected because vendors forgot to incorporate them,\u201d he says. \u201cAlso, you need to test in-house to make sure it will function in your environment not the very sterile test bed that the vendor might use.\u201d

When it comes to the end of the Medicare grace period on code specificity for Part B post-payment audits, Daley points out that prior leniency in specificity of codes will be going away October 1, with the new mandate that goes into effect. That one-year \u201caccommodation\u201d period was the result of an agreement between CMS and the American Medical Association (AMA).

In the past, CMS reimbursed incorrectly coded claims under the Part B physician fee schedule\u2014provided that the incorrect code was from the right ICD-10 code family\u2014but no longer, according to Daley. \u201cIf you got close to the right general category of the codes, they wouldn\u2019t penalize you in an audit,\u201d he adds. \u201cThat\u2019s ending.\u201d

To be in compliance, Daley says organizations need to ensure that clinical documentation contains sufficient detail to code at the required level of specificity that CMS will soon demand.

In related news, CMS on August 18 released updates<\/a> to its \u201cClarifying Questions and Answers Related to the July 6, 2015, CMS\/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities\u201d in which the agency addressed the issue of code specificity.

\u201cAs of Oct. 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines,\u201d states the question-and-answer document. \u201cRemember that many major insurers did not offer coding flexibility, so many providers are already using specific codes.\u201d

At the same time, CMS states: \u201cBeginning Oct. 1, 2016, all CMS review contractors are able to use coding specificity as the reason for an audit for a denial of a reviewed claim to the same extent that they did prior to Oct. 1, 2015. Review contractors will notify providers of coding issues they identify during review and of steps needed to correct those issues to the same extent that they did prior to Oct. 1, 2015.\u201d

Based on the new specificity offered by ICD-10, Daley thinks that health payers may begin to adjust medical policies and that organizations should communicate with them to identify potential changes.

\u201cThat\u2019s not to say that it will happen on October 1,\u201d Daley concludes. \u201cWith time under their belts, the question is whether payers will be changing some of their medical policies? Now that they have new granularity around codes, it\u2019s conceivable they might decide to cover some situations and not necessarily others. I\u2019m not saying it\u2019s going to happen overnight but it\u2019s something to look for.\u201d
","saveContent":"While last year\u2019s ICD-10 transition went smoothly and with very few hiccups, healthcare organizations do not have the luxury of resting on their laurels. October 1 marks the one-year anniversary of the code switchover, which brings new challenges they must overcome.

Jim Daley, director of IT for BlueCross BlueShield of South Carolina and past chairman of the Workgroup for Electronic Data Interchange as well as WEDI\u2019s ICD-10 co-chair, credits the success of organizations in meeting the Oct. 1, 2015, implementation deadline to the fact the industry had a lot of time to prepare.

One year later, Daley contends that organizations must now focus on three significant changes that will come into play starting Oct. 1, 2016:
- Payers may begin to adjust medical policies based on the new specificity offered by ICD-10.<\/li><\/ul>
  According to Daley, the coding update to be implemented on Oct. 1, 2016, will include a backlog of changes to the code set proposed by the ICD-10 Coordination and Maintenance Committee. He notes the large number of new codes are a result of the fact that a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes that existed prior to the Oct. 1, 2015, ICD-10 transition deadline has been lifted.
  
  The Centers for Medicare and Medicaid Services reports that there are 71,486 diagnosis and 75,789 procedure codes for FY 2017. These include 1,974 additions, 311 deletions, and 425 revisions for ICD-10-CM, and 3,827 additions, 12 deletions, and 491 revisions for ICD-10 PCS, respectively.
  
  \u201cThe impact of those new codes depends on what you do for a living,\u201d says Daley, who argues that it\u2019s important to determine the applicability of the new or revised codes specific to your practice or facility. \u201cIf you don\u2019t happen to deal with the areas where the codes have changed, the impact will be obviously a lot less than if they\u2019re right in the middle of your specialty.\u201d
  
  He recommends that organizations make sure that applicable codes are incorporated into internal applications and processes, while verifying that vendor products support the new codes. In addition, Daley warns not to rely solely on software vendors for testing.
  
  \u201cI would think that most of the major vendors are on top of this and are up to date, but you certainly don\u2019t want to have new codes rejected because vendors forgot to incorporate them,\u201d he says. \u201cAlso, you need to test in-house to make sure it will function in your environment not the very sterile test bed that the vendor might use.\u201d
  
  When it comes to the end of the Medicare grace period on code specificity for Part B post-payment audits, Daley points out that prior leniency in specificity of codes will be going away October 1, with the new mandate that goes into effect. That one-year \u201caccommodation\u201d period was the result of an agreement between CMS and the American Medical Association (AMA).
  
  In the past, CMS reimbursed incorrectly coded claims under the Part B physician fee schedule\u2014provided that the incorrect code was from the right ICD-10 code family\u2014but no longer, according to Daley. \u201cIf you got close to the right general category of the codes, they wouldn\u2019t penalize you in an audit,\u201d he adds. \u201cThat\u2019s ending.\u201d
  
  To be in compliance, Daley says organizations need to ensure that clinical documentation contains sufficient detail to code at the required level of specificity that CMS will soon demand.
  
  In related news, CMS on August 18 released updates<\/a> to its \u201cClarifying Questions and Answers Related to the July 6, 2015, CMS\/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities\u201d in which the agency addressed the issue of code specificity.
  
  \u201cAs of Oct. 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines,\u201d states the question-and-answer document. \u201cRemember that many major insurers did not offer coding flexibility, so many providers are already using specific codes.\u201d
  
  At the same time, CMS states: \u201cBeginning Oct. 1, 2016, all CMS review contractors are able to use coding specificity as the reason for an audit for a denial of a reviewed claim to the same extent that they did prior to Oct. 1, 2015. Review contractors will notify providers of coding issues they identify during review and of steps needed to correct those issues to the same extent that they did prior to Oct. 1, 2015.\u201d
  
  Based on the new specificity offered by ICD-10, Daley thinks that health payers may begin to adjust medical policies and that organizations should communicate with them to identify potential changes.
  
  \u201cThat\u2019s not to say that it will happen on October 1,\u201d Daley concludes. \u201cWith time under their belts, the question is whether payers will be changing some of their medical policies? Now that they have new granularity around codes, it\u2019s conceivable they might decide to cover some situations and not necessarily others. I\u2019m not saying it\u2019s going to happen overnight but it\u2019s something to look for.\u201d
  ","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Healthcare organizations face new set of ICD-10 challenges

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