ICD-10 denial coverage is not the same as denial of coverage

Carl Natale
by Carl Natale
ICD-10 denial coverage is not the same as denial of coverage

We're still in the ICD-10 denial stage. Meaning healthcare officials deny we have enough data to determine whether the ICD-10 transition is a success or not.

Except for Rhonda Butler at the 3M HIS Blog. She's using the lack of data and judgment as a sign that the ICD-10 transition is nothing to worry about. Her latest post is based upon the following points:

  • "Historically only 0.17% of the total claims denied are for an invalid ICD-9 code."
  • According to the Centers for Medicare and Medicaid Services (CMS) after one month of ICD-10 coding, denial rates for ICD-9 and ICD-10 claims are down.
  • Hospitals aren't raising any real issues.
  • So no one should worry about ICD-10 coding increasing rejections or denials.

If I didn't worry about the ICD-10 denial rate, I wouldn't have much to write about. And apparently neither would a bunch of other healthcare writers.

ICD-10 Tip of the Week: Establish an ICD-10 denial management team

An ICD-10 denial group can:

  • Review claim payments and process problems.
  • Identify patterns.
  • Educate clinicians, documentation specialists and medical coders.

Should be comprised of:

  • CDI
  • Billing
  • HIM
  • Patient financial services

(ACDIS Blog)

Short Video Shows Steps to Manage ICD-10 Denials




  1. "Closely monitor denials and rejections" Daily.
  2. "Watch for denial trends." Track by payer, frequency and type.
  3. "Make changes based upon denial reasons." Once you see patterns, educate.
  4. "Be prompt." Fix problems quickly.

They also have a guide, "5 Steps to Prevent and Manage Denials."


Providers Not Required to Revise Physician Orders Written Before Oct 1: New CMS FAQ

In response to questions from the provider community, CMS posted a new FAQabout physician orders written before the October 1 ICD-10 compliance date.
FAQ 12625 explains that CMS is not requiring the ordering provider to translate ICD-9 diagnosis codes to ICD-10 on orders written before October 1 for lab, radiology, or any other services.

In brief:

  • Orders written before October 1 should have a ICD-9 codes.
  • For orders written before October 1 for services that will continue to be delivered and billed after October 1, providers can opt to use the General Equivalence Mappings (GEMs) to translate the ICD-9 codes on the original order to ICD-10. Providers are not required to update codes to ICD-10 for orders written before October 1.
  • Orders written on or after October 1 must use ICD-10.

For more guidance on claims processing and billing, please visit the CMS ICD-10 FAQ webpage. (Centers for Medicare and Medicaid Services)

CA Providers Report Smooth Transition to ICD-10

  • California Department of Health Care Services (DHCS) reports a minimal increase in claim denials.
  • California hospitals are reporting widespread problems.
  • Clinicians are expressing frustration at extra time needed to assign diagnoses.
  • Many of the issues can be tracked to specific (and unnamed) electronic medical record systems.

(Health Leaders Media)

ICD-10 Transition: Monitor to Catch Problems Early

  • Review and monitor top ICD-10 diagnoses - not just denied claims.
  • Review accounts receivable weekly instead of monthly.
  • Enforce ICD-10 specificity before Medicare or other healthcare payers do.
  • Create ICD-1 cheat sheets for common diagnoses.
  • Audit coding regularly.

(Physicians Practice)

Detailed Coding in ICD-10 Avoids Revenue Headaches

There's an interesting story from Deborah Grider about a medical practice that had about 60 Medicare claims denied early in October. The reason was invalid ICD-10 codes. But the practice couldn't find the problem. When it went to the (unnamed) clearinghouse, it was discovered a glitch was stripping off the seventh character from the ICD-10 codes.

This is why medical practices need to jump on denials quickly. It may be a fixable problem causing denials. (Physicians Practice)

Why ICD-10 Coding Demands a Focused Compliance Perspective

  • Still early to judge the ICD-10 transition.
  • Clinical documentation needs to support the ICD-10 codes


Life after ICD-10 at Great Lakes Eye Care

Allscripts interviews one its clients who says the interfaces on their systems worked like magic. So take this with a grain of salt. (Allscripts Blog)