Primary Care Coding Alert

Question: Has CMS ended the 90-day grace period for getting used to new ICD-9 codes? I've heard that I must use the new diagnosis codes the day they are available.

Massachusetts Subscriber

Answer: Yes, it is true. The Centers for Medicare & Medicaid Services has scrapped the 90-day grace period you once had for implementing new ICD-9 codes, according to two CMS transmittals (Nos. 89 and 95) from February. However, the new rule shouldn't cause your family practice many problems - as long as you are familiar with the new codes before you are required to use them.

The grace period was previously allowed so providers could "ascertain the new codes and learn about the discontinued codes," CMS says. But HIPAA's "transaction and code set rule" mandates that physicians and practices report codes that are valid at the time the physician rendered the service.

Translation: You will have to begin using new and revised ICD-9 codes when CMS introduces them on Oct. 1, 2004, and you will not be allowed to continue using the old codes for 90 days.

What to do? Update your encounter forms by the ICD-9 and HCPCS deadlines.

CMS already has a file containing the new codes on its Web site available for download. To get a copy of the file, go to www.cms.hhs.gov/medlearn/icd9code.asp. Then, look for the link to Table 6-A under the "Effective October 1, 2004" heading on the left side of the page.

You should download the file, print it out, and make copies for all the relevant personnel in the office as soon as possible.

Filer, beware: Some insurance carriers may not be ready to use the codes on Oct. 1, even if you are. If a carrier denies a CPT code linked to a new (and correct) ICD-9 code, talk to a carrier representative.