New Bill Proposes Two Year Grace Period for ICD-10

Although it will not delay the transition to ICD-10-CM/PCS, a new bill before the US House of Representatives is proposing a two year grace period, during which Medicare and Medicaid will be required to pay all claims, regardless of ICD-10 related coding errors. To get alerts on H.R.2652 – Protecting Patients and Physicians Against Coding Act of 2015, click here.

The bill is designed to ensure that doctors and medical providers are not denied payment due to coding errors and oversights while the new code set is successfully implemented across the healthcare system. The bill will not change the October 1, 2015 implementation date for ICD-10, but it will require the Centers for Medicare and Medicaid Services (CMS) to continue to pay for claims that may contain errors or inaccurate codes. The grace period will allow providers the necessary time to become familiar with and convert to ICD-10, without suffering penalties and claim denials.

What Will Change Under ICD-10?

The implementation of ICD-10 was designed to modernize the coding process and give providers more flexibility in terms of filing claims and organizing patient data. The ICD-10 structure was designed by a committee of physicians to allow coding for subspecialties, as well as additional detail on individual diagnoses.

ML Medical Billing - ICD -10

The goal of the new code structure is to modernize the reporting process to account for changes and standard practice developments over the last 30 years. ICD-10 will update medical documentation procedures to capture more detail in the documentation of patient care.

Some of the improvements and changes between ICD-10 and ICD-10 diagnosis codes include:

·      ICD-10 allows for 7 digits, as opposed to 3-5 under ICD-10, and will allow for “X” placeholders

·      There are 69,000 codes under ICD-10 (as opposed to 14,000 under ICD-10) to allow for more specificity in coding

·      2 types of Excludes Notes as opposed to 1 under ICD-10

·      Expanded Combination Codes to allow for more detailed reporting and to better capture complexity in diagnostic notes

·      Injuries are grouped by anatomical site as opposed to the type of injury

·      Certain definitions have been updated to reflect revisions in standard medical practice over the years. For example, the definition of acute myocardial infarction has been changed to 4 weeks, where it was previously 8 weeks

·      Certain diseases have been reclassified to reflect progress and developments in the medical industry