Following the July 27 issued ICD-10 frequently asked questions list, the Centers for Medicare & Medicaid Services (CMS) has updated some of the information.
These updates primarily clear up confusion regarding family codes and what qualifies as a billable code, otherwise known as a valid code.
As reported by RevCycleIntelligence.com, CMS released the frequently asked questions document to help providers understand the transition to ICD-10 and help them understand the flexible policies CMS will be practicing for the first year following ICD-10 implementation.
The flexible policy CMS will be practicing during the first 12 months following implementation means that as long as Medicare or Medicaid claims are filed under the valid family code, they will not be audited if it is not filed under the correct specific code.
These flexible policies do not mean that CMS is stalling implementation any further. It will still take place on October 1.
Updates were made to questions 3 and 5 of the FAQ document
In question 3, CMS provides information about what a billable claim code is, and explains the different classification of the codes. Three-character codes are called family codes, and refer to the general disease. Family codes may be broken down further by adding additional characters to make the diagnosis more specific. Each additional character corresponds to a different sub classification of the disease. CMS states that family codes are not billable codes unless the disease cannot be further broken down. Instead, a provider must submit a code that further specifies the diagnosis.
CMS provides the example of Hodgkin’s lymphoma (C81). The 3-character code, C81, is not a billable code; however, C81.03 (Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes) is a valid claim code because it provides a specific diagnosis.
CMS says that the ultimate goal of IDC-10 implementation is to use the correct specific code for the given diagnosis. However, part of the organization’s implementation flexibility states that so long as a specific code under the proper family code is provided, claims will not be audited for the first 12 months following implementation.
CMS also revised question 5, which gives providers a definition of a family code. As stated above, family codes are the 3-character codes given to a general diagnosis. For example, K50 is the family code for Crohn’s disease, and K50.90 is the specific code for Crohn’s disease, unspecified, without complications.
In the cases of both question 3 and question 5, the revisions made provide more specificity and examples to help explain ICD-10 implementation to healthcare providers. CMS also takes special notice to remind providers that there is a free codebook which features all ICD-10 claim codes, and that it can be used for reference during the transition.
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Photo courtesy of: RevCycle Intelligence
Originally published on: RevCycle Intelligence
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