CMS clarifies what is an ICD-10 family
The detente between the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) calls for physician practices to use ICD-10 codes in the correct family in order to qualify for reimbursement.
It wasn't until this week that CMS clarified what family meant.
It's the first three characters of an ICD-10 code.
CMS uses Hodgkin's lymphoma as an example. Consider these ICD-10 codes:
- C81.00: Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site
- C81.03: Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
- C81.10: Nodular sclerosis classical Hodgkin lymphoma, unspecified site
- C81.90: Hodgkin lymphoma, unspecified, unspecified site
Until Oct. 1, 2016, it will be fine to use C81.00 even if any of the other three codes could be used. But there are a couple points worth emphasizing:
- C81.00 is correct but C81 is not. The latter will not be accepted. That will be the same among many ICD-10 families. I'm predicting this will mean many rejections for physician practices who figure "close enough for government work."
- This family flexibility applies only to Medicare fee-for-service claims, not Medicaid or private healthcare payer claims. ICD-10 specificity will still matter.
- National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) may require something more specific than the correct family.
A year from now, I doubt many physicians will be saying how happy they are that CMS created this ICD-10 family flexibility.
Sue Bowman, American Health Information Management Association (AHIMA) senior director of coding policy and compliance, and Rhonda Buckholtz, American Academy of Professional Coders (AAPC) vice president of ICD-10 training and education, address some of the concerns that physicians express about ICD-10 implementation:
- ICD-10 terminology more closely reflects modern clinical terminology than ICD-9 terminology.
- 46 percent of the increase in ICD-10 specificity comes from laterality.
- Physician groups asked for greater specificity in diagnoses.
- The increase in diagnosis codes does not make it harder to assign an ICD-10 code.
- While it would be great to have physicians represented as a cooperating party, they already have a major role in the development of ICD-10 coding.
A short list of the diseases and what endocrinologists can code:
- Cushing's syndrome
- Endocrine and metabolic disorders
Not unless you want to put them to sleep without anesthesia. But ICD-10 coding is something they really don't want to know about.
Except Robert Tenant,, has this suggestion for physicians to explain any delays to patients:
"Additional government regulations are requiring extra paperwork. Most patients will have no trouble understanding or sympathizing."
That's almost as funny as that "Walked into a lamppost" joke that ICD-10 opponents like to tell. (Physicians Practice)
This argument makes the case that using ICD-9 and ICD-10 codes at the same time would create more problems than it solves. (Coalition for ICD-10)