ICD-10 Is Almost Here- What Flexibility Is There In Coding?

On October 1, 2015, Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. ICD-10 is composed of codes with three, four, five, six or seven characters. Codes with three characters are included in ICD-10 as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity.

Medicare’s goal is to be flexible in coding for the first year after ICD-10 implementation due to the variations in code families. This flexibility is not applicable to Medicare advantage plans, Medicaid, or other health care providers. Medicare stated that a claim can still be rejected if a responsible reporting entity does not utilize a valid code. It is important for Section 111 users to utilize the correct code or a claimant can be denied future Medicare coverage.

Further, Medicaid claims will also be transitioning to ICD-10 coding for a date of service on or after October 1, 2015. If a person has dual eligibility, Medicare may pay part of the claim and Medicaid may pay another part of the claim. The coding under Medicare can be utilized for Medicaid’s purposes. Medicaid will not have the same ICD-10 flexibility that Medicare is providing. The bottom line is that it is important to provide the correct ICD-10 code. If you have questions or concerns about the appropriate code to utilize in your case, please feel free to contact me at marci@aenlaw.com.

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