Oncology & Hematology Coding Alert

Make sure you are submitting codes from the ‘right family.’

CMS and AMA made a joint announcement on July 6 that for 12 months after ICD-10 implementation, Medicare won’t deny Part B claims based just on ICD-10-CM code specificity as long as the code is from the “right family.” This announcement comes after AMA officials have publicly supported bills introduced over the past few months designed to stop ICD-10-CM implementation or at least provide a grace period.

But, Medicare made it clear in the announcement that “diagnosis coding to the correct level of specificity is the goal for all claims.” Providers still should aim to improve documentation and coders still should assign the most specific code possible. If during the 12-month period you find documentation does not include necessary details, keep track of the specific issues to create customized clinical documentation improvement training for providers and adjust your superbills and other job aids to resolve any problem areas in the first year.

Review the related guidance document with additional information at www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf.