CMS issues ICD-10 flexibility clarifications

In a series of FAQs, the Centers for Medicare & Medicaid Services (CMS) clarified its earlier policy announcement regarding expanding flexibility for practices submitting Medicare claims containing ICD-10 diagnosis codes. CMS reiterated that all claims with dates of service of Oct. 1, 2015 or later must be submitted with a valid ICD-10 code and that ICD-9 codes will no longer be accepted for these dates of service. Additionally, in certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an applicable policy, such as Local Coverage Determinations or National Coverage Determinations. This reflects the fact that current automated claims processing edits are not being modified as a result of the flexibility guidance. The permitted 12-month flexibility only applies to Medicare review contractors—they will not deny claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code, as long as a valid code from the right family of codes (defined now as the ICD-10 three-character category) was used.