ICD-10, Thoughts On a Smooth Transition

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

ICD-10, Thoughts On a Smooth Transition
The computers of America made the transition to the International Classification of Disease, Revision 10 (ICD-10) without any major incidents on October 1. Much like all the hype of Y2K, the transition to ICD-10 occurred with no real problems reported. After a month of implementation, I offer the following observations:

  • Physicians are still clinging to old habits. Using crosswalks to do the work for them, or selecting codes that are “close enough” shows a continued lack of specificity in coding and documentation.
  • Many physicians are in denial. Citing the 12-month safe harbor agreement announced by CMS, physicians continue unwisely to use unspecified codes.  
  • The safe harbor allows for “flexibility” in code selection with the use of any code from a “family of codes,”  but includes important limitations:
         The safe harbor is for 12 months ending October 1, 2016. The use of unspecified codes defeats the purpose of ICD-10, specificity, when “better” information is documented or known.
         The safe harbor applies only to Medicare claims. No other major carrier has adopted this temporary rule.
         The safe harbor does not apply when there is a specific payable diagnoses listed.
         CMS’s guidance indicates it “only applies to Medicare fee-for-service claims from physician or other practitioner claims.”

Do not be misled into continuing to select unspecified codes believing they are payable for all carriers in all situations. This is not the case. “Close enough” in medical diagnostic coding will not serve you well where greater specificity is available and it will be required in less than a year.  

Stay True to Why You Pursued Medicine.