CMS and AMA Release Clarifications on ICD-10 Guidance

On July 27, in response to questions from healthcare providers, the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) released clarifications on their ICD-10 guidance for the medical diagnosis codes that take effect Oct. 1.

Earlier this month, also in response to requests from the provider community, CMS provided additional guidance on new ICD-10 codes for medical diagnoses and inpatient procedures, ACA International reported.

The information allows for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

Since the guidance information was released, healthcare providers sought confirmation on the implementation date, what constitutes a valid ICD-10 code, filing claims and what to do if they are rejected, among other topics, according to a news release from CMS.

According to the release and response to a question from the provider community, the guidance and additional resources from CMS do not mean there is a delay in the Oct. 1 implementation of the ICD-10 code set for Medicare or any other organization.

CMS and AMA also confirmed the availability of an ICD-10 ombudsman who will help receive and prioritize physician and provider issues. The ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns.

Valid ICD-10 codes include between three and seven characters and CMS has a complete list of the valid codes available here. Codes that are not valid can result in denial of a claim, but providers will receive confirmation the claim was rejected due to the code rather than another reason and procedures to follow to fix the claim.

CMS and AMA are providing educational resources including webinars, on-site training, articles and national provider calls to help physicians and other healthcare providers learn about the updated codes and prepare for the transition.

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. According to CMS, the diagnosis and billing medical codes in the U.S. have not been updated in more than 35 years and contain outdated, obsolete terms. 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, according to CMS.

In addition, CMS has multiple resources on its ICD-10 website and Roadto10.org, a site built with input from providers at smaller medical practices.