After a push by the AMA for a two-year transition period after implementation to protect physicians from all ICD-CM coding errors and mistakes, CMS (The Centers for Medicare and Medicaid Services)and the AMA made a joint announcement today that appears to signal a burying of the hatchet. It looks very likely now that the October 1 implementation date for ICD-10 will happen.To gain that concession from the AMA, CMS and the AMA reached a compromise.
For one year after implementation of ICD-10, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Similarly, physicians will not be penalized for the value-based payment modifier or Meaningful Use due to specificity of diagnoses. CMS has also authorized advance payments to physicians if Medicare contractors can’t process claims due to problems related to ICD-10.
The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes used in the US for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms. The use of ICD-10 should support supposedly innovative payment models that drive quality of care.
So after a few years of uncertainty, ICD-10 on October 1, 2015 appears to be a reality. We all hope it is a smooth implementation, something the federal government hasn’t historically done well, especially with the healthcare regulatory changes the past few years.
A. J. Rosmarin
July 2015
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