News Briefs Archive

CMS and AMA Cooperating to Ease Transition to ICD-10

July 15, 2015

As health care professionals prepare to switch to ICD-10 coding for medical diagnoses from ICD-9 codes (deadline October 1, 2015), the Centers for Medicare & Medicaid Services (CMS) announced that it is working with the American Medical Association (AMA) to ease the transition.

Among the additional guidance released that will allow for flexibility in claims auditing and quality reporting, CMS announced that for 12 months after ICD-10 implementation it will not deny claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code as long as the practitioner used a valid code from the right family of codes.

Get Ready for ICD-10

For additional information on steps that eyecare professionals can take to prepare for ICD-10, see “Countdown to ICD-10: 10 Steps to Get Ready, Set, Go!”

In addition, CMS also announced in the guidance released this week: “For all quality reporting completed for program year 2015, Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes. Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM or MU due to the transition to ICD-10 codes.”

CMS will set up a communication and collaboration center for monitoring the implementation of ICD-10. This center will identify and initiate resolution of issues that arise as a result of the transition to ICD-10. As part of the center, CMS will have an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns.

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. “The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms,” according to the CMS announcement, “The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.”

CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios and other specialty-specific resources to help with implementation. CMS has also released provider resources that include a quick-start guide, infographic, training videos and webinars that offer helpful ICD-10 implementation tips.

For additional information on steps that eyecare professionals can take to prepare for ICD-10, see “Countdown to ICD-10: 10 Steps to Get Ready, Set, Go!” For a list of ICD-10 educational opportunities, see “Additional ICD-10 Resources.”

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