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

As you are aware, on October 1, the Medicare claims processing system is set to begin using the new ICD-10 codes. I wanted to provide a few tips and updates in response to some of your most pressing questions to help ease this transition process. While many of us may have benefited from the delay in ICD-10 implementation, which was originally scheduled for last October, here are some recent updates and additional tips that you may find helpful.

For more information, ACG has also prepared a helpful ICD-10 Playbook, including ICD-10 Coding Cheat-Sheets where you can easily search by GI category. Please visit the ACG website for other coding information and ICD 10 resources specific to GI.

CMS Eases ICD-10 Transition with 1-Year of Flexibility

CMS released guidance on July 6 that allows for flexibility in the implementation phase of ICD-10 to help ease the transition from ICD-9 to ICD-10.

This includes:

  1. Claims Denials: For the first year, CMS will not deny claims solely based on the lack of specificity of diagnosis codes as long as they are in the appropriate diagnostic code family. You will not be penalized for coding errors due to lack of coding to the higher level of specificity.
  2. Quality reporting: No penalties for coding errors in selecting and calculating quality codes for quality reporting programs including Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the value-based payment modifier (VBM) as long as they are codes within the appropriate code family.
  3. Payment disruption: CMS will authorize payments to physicians in the event of some unforeseen inability of Medicare contractors to process claims as a result of the transition to ICD-10.
  4. Managing transition problems: CMS plans to create a dedicated communication center to help and assist with problems that arise from the ICD-10 transition.

Tips for a Smooth Transition

  1. Claim Form Change: You should have already transitioned from using the CMS 4010 claims form to CMS 5010. This was done last year in advance of the anticipated transition, so you should already be in compliance.
  2. EMR Check: Check with your EMR provider to make sure they are ICD-10 compliant. If you have received ICD-10 code updates, test them out by searching certain diagnoses to see if these new codes come up with your search. Ask your EMR provider for help with testing the system for assurance.
  3. Go beyond the EMR: Software compliance doesn’t end with your EMR system.   Make sure you:
    • Get similar assurances of ICD-10 compliance from your practice management system.
    • Check with your claims clearing house provider as well as billing service if you use one.
    • Update your endowriter system. Although some practices will have these new ICD 10 codes feed directly into their practice management system, other situations, such as hospital endoscopy units, only generate the report. Having the hospital systems updated is still important in helping your office staff reduce coding errors while filing claims for your procedures. This ultimately saves your billing staff time in this process.
  4. Submit test claims: Once you have assurances from all software vendors involved, you should submit test claims using ICD-10 coding to make sure they go through without problems. It’s vital to test well in advance of the October 1st deadline to ensure that everyone has enough time to fix any issues. If you do experience any problems, switching back to ICD-9 may not be possible, so I urge you to submit test claims as soon as possible.  Although CMS is promising leniency in this area, advance testing will save you time and help make this a smooth transition.
  5. Staff training: Your office billing and insurance staff are the critical keys to the successful use and implementation of ICD-10 and must be familiar with these coding changes, especially when it relates to claims denials. Your familiarity with these changes will also aid in a smoother transition.

This is a basic overview to help you and your staff assess whether or not you are properly prepared for the ICD-10 transition.

Good luck and I hope this helps,

Caroll Koscheski, MD, FACG