Posted in ICD-10 & Coding

ICD-10 safe harbor relieves specificity not medical necessity

Carl Natale
by Carl Natale
ICD-10 safe harbor relieves specificity not medical necessity

There is concern that medical practices will feel a lot of pain when healthcare payers require more specific ICD-10 codes. But there may be a bigger problem with medical necessity.

The Centers for Medicare and Medicaid Services (CMS) and some private payers may be willing to accept ICD-10 codes from the correct family of codes. But medical claims cannot skip ICD-10-CM codes that support medical necessity.  The safe harbor does not apply to National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

Denise Williams, senior vice president of revenue integrity services at Revant Solutions, writes "If there is a specific code required to support medical necessity, then all characters of the code must be accurate to meet medical necessity."

Here's a round up of recent articles and posts on how to code diagnoses and procedures in ICD-10:


#ICD10 Code of the Week: L10.5: Drug-induced pemphigus (Medscape)

This is a weekly feature that I use to highlight practical tips on how to use and understand ICD-10-CM/PCS codes. Please let me know of any other sources that I can include.