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    The end of ICD-10 flexibilities is coming, are you ready?

    Providers who are still adjusting to the ICD-10 coding transition from five characters to seven have a variety of amenities and advice available to them in the last leg of the grace period.

    The flexibilities that the Centers for Medicare and Medicaid Services (CMS) allowed for following the launch of ICD-10 October 1, 2015—such as a leniency in the specificity of the codes submitted by providers—will be ending October 1, 2016.

     

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    As a result of the grace period's conclusion, Jackie Stack, BSHA, CPC, an education specialist at the American Academy of Professional Coders, says providers should prepare for more audits and denials of claims, especially if codes they're submitting are unspecified.

    “If you have the providers who really base most of their diagnoses on reporting on these unspecified codes, it's going to be a huge financial hit to that provider if Medicare starts to not pay based off of those codes,” Stack says.

    The CMS released a Q&A list in August, providing guidance to the wrap-up for the flexibilities. One CMS example indicates the difference between “valid codes” and the “correct code.” If a patient receives the diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus), then G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus), have not been “cause for an audit” during the grace period because those codes fall within the same family of codes, as noted by the first three characters.

    Providers need to “make sure the clinical documentation is a complete and accurate reflection of the patient’s clinical picture and that the codes are as specific as possible based on that documentation,” Sue Bowman, RHIA, FAHIMA, senior director, coding policy and compliance at the American Health Information Management Association, said in an email to Medical Economics.

     

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    “This will help to reduce claims denials, support medical necessity, obtain proper reimbursement, and accurately reflect clinical complexity and severity of illness.”

    Many providers are already familiar with using specific codes because many major insurers did not offer a grace period, she notes.

    Next: Avoiding an undue financial burden

    Hannah Douglas
    Hannah Douglas is a freelance writer for Medical Economics.

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