Carroll D. Koscheski, MD, FACG
Carroll D. Koscheski, MD, FACG

In response to concerns from ACG and the provider community, the Centers for Medicare and Medicaid Services (CMS) this week released additional guidance that will allow for flexibility in the claims processing and quality reporting process as the new ICD- 10 code set begins October 1, 2015.  Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.

However, for 1 year after ICD-10 implementation, Medicare contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule based upon specificity errors of the ICD-10 diagnosis code, as long as the physician/practitioner uses a valid ICD-10 code from the right family.

For all quality reporting completed for program year 2015, Medicare will not subject physicians and other Eligible Professionals (EP) to penalties under the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use (MU) penalty due to the specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of ICD-10 codes.

Furthermore, physicians and  EPs 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.

Please visit ACG the website for further guidance on ICD-10, including a “ICD-9 to ICD-10 code converter,” which a free benefit for ACG members.

Access ACG ICD-10 Guidance