ICD-10 Flexibility Period Ends October 1 – Are You Ready?

Date of Publication (August 31, 2016)

To assist with the transition from ICD-9 to ICD-10, the Centers for Medicare & Medicaid Services (CMS) and commercial carriers, implemented a flexibility period. During this period claims, have been processed as long as a valid ICD-10 code from the same family of codes was used. On October 1 the flexibility period comes to an end. It is important to remember that using the most specific code available will help to ensure that claims are not denied.

CMS recently updated their frequently-asked questions (FAQ) on the ICD-10 flexibility period. Within the FAQ CMS addresses concerns such as:

The level of specificity required so that claims will not be rejected; CMS recommends using as much specificity as possible and avoiding unspecified ICD-10 codes when documentation supports using a more detailed code.

Using unspecified codes — CMS says that appropriate use of unspecified codes will be allowed once the ICD-10 flexibility period expires and that these codes will continue to have necessary uses.

How this will affect audits that begin after October 1, 2016, but are for claims with dates of service before October 1, 2016 — CMS states, beginning October 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 October 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 October 1, 2015.

CMS Resources on ICD-10 and the End of the Flexibility Period — In addition to its FAQs on the flexibility period, CMS offers a number of other resources to help answer questions about ICD-10: