Gastroenterology Coding Alert

Avoid future problems by working with your physicians on added specificity.

There is good news on the diagnosis coding front. According to a recent CMS guidance document, Medicare will give coders a wide berth when it comes to diagnosis coding specificity next year.

From Oct. 1, 2015 until Oct. 1, 2016, Medicare payers will not deny claims “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right [ICD-10 code] family,” according to the report.

“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said Steven J. Stack, MD, president of the American Medical Association (AMA) in a statement on the AMA Website (www.ama-assn.org/ama/pub/news/news/2015/2015-07-06-cms-ama-help-providers-icd-10.page). “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs. The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

Caution: You should not take this new information as a license to be lazy with diagnosis coding next year; you should still strive to choose the proper ICD-10 code every time. But, if you don’t code the diagnosis completely right, at least you won’t be looking at a potential denial. This would also be the time to work with your physicians, making certain they are providing you with the needed additional information to code more specifically and accurately.

Resource: Check out the guidance document for yourself at www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf.