CMS Issues Q&As on ICD-10 Claims Flexibility.

Date posted: September 3, 2015

The Centers for Medicare & Medicaid Services (CMS) recently issued questions and answers (Q&As) on International Classification of Diseases, Tenth Revision (ICD-10) guidance issued by CMS and the American Medical Association.

For 12 months after ICD-10 implementation, CMS will not deny claims billed under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code.  However, a practitioner must use a valid code from the correct family of codes.  Codes in the same family are codes within the same ICD-10 three-character category.

The recent guidance does not change the coding specificity required by National Coverage Determinations and Local Coverage Determinations. Coverage policies that require a specific diagnosis under International Classification of Diseases, Ninth Revision (ICD-9) will continue to require a specific diagnosis under ICD-10.  The coverage policies will not require greater specificity in ICD-10 than was required in ICD-9, except for laterality, which does not exist in ICD-9.

Medicare claims with a date of service on or after October 1, 2015 must contain a valid ICD-10 code.

The Q&As are available at:

The CMS and AMA guidance is available at:

Centers for Medicare & Medicaid Services. “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.”  27 Jul. 2015.

Centers for Medicare & Medicaid Services and the American Medical Association.  CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10.  6 Jul. 2015.

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